High Early Event Rates in Patients with Questionable Eligibility for Advanced Heart Failure Therapies: Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry

Background The prognosis of ambulatory advanced heart failure (HF) patients who are not yet inotrope dependent and implications for evaluation and timing for transplant or destination therapy left ventricular assist device (DT-LVAD) are unknown. We hypothesized that the characteristics defining eligibility for advanced HF therapies will be a primary determinant of outcomes in these patients. Methods Ambulatory patients with advanced HF (NYHA class III-IV, INTERMACS profiles 4-7) were enrolled across 11 centers from 5/2013-2/2015. Patients were stratified into 3 groups: likely Transplant Eligible, DT-LVAD Eligible, and Ineligible for both Transplant and DT-LVAD. Clinical characteristics were collected and patients were prospectively followed for death, transplant, and LVAD implantation. Results A total of 144 patients were enrolled with a mean follow up of 10±6 months. Patients in the Ineligible cohort (n=43) had worse congestion, renal function, and anemia compared to Transplant (N=51) and DT-LVAD (N=50) Eligible patients. Ineligible patients had higher mortality (23.3% vs. 8.0% in DT-LVAD and 5.9% in Transplant, p=0.02). The differences in mortality were related to lower rates of transplantation (11.8% in Transplant vs. 2.0% in DT-LVAD and 0% in Ineligible, p=0.02) and LVAD implantation (15.7% in Transplant vs. 2.0% in DT-LVAD and 0% in Ineligible, p