Log in to MyACC
INTERMACS Profiles and Outcomes in HFrEF
Study Questions:
What is the prognostic use of INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles among ambulatory non–inotrope-dependent patients with heart failure with reduced ejection fraction (HFrEF)?
Methods:
The study authors evaluated 3-year outcomes in 969 non–inotrope-dependent outpatients with HFrEF (EF: ≤40%) not previously receiving advanced HF therapies. Patients meeting an INTERMACS profile at baseline were classified as profile 7 (n = 348 [34.7%]), 146 patients (14.5%) were classified as profile 6, and 52 patients (5.2%) were classified profile 4-5. The remaining patients were classified as stable Stage C (n = 423 [42.1%]). The endpoints evaluated: 1) all-cause mortality and the composite endpoint of death, left ventricular assist device (LVAD) implantation, or heart transplantation (time to first event); 2) hospitalization rates (all-cause and HF-related) over the entire 3-year follow-up period; and 3) days spent in the hospital on an annual basis (all-cause and HF-related). The study authors used Cox proportional hazards models to estimate hazard ratios for mortality and the composite of death, LVAD implantation, or heart transplantation.
Results:
The study authors found that 1-year mortality rates, which are commonly used as a criterion for advanced HF therapy referral, were 2.5%, 5.1%, 15.1%, and 19.5% among patients with baseline stable Stage C and INTERMACS profiles 7, 6, and profile 4-5, respectively. Corresponding 1-year composite endpoint rates were 2.5%, 6.0%, 15.8%, and 25.6%, respectively. Three-year mortality rate was 10.0% among stable Stage C patients compared with 21.8% among INTERMACS profile 7 (hazard ratio [HR] vs. Stage C: 2.45%; 95% confidence interval [CI], 1.64-3.66), 26.0% among profile 6 (HR, 3.93; 95% CI, 1.64-3.66), and 43.8% among profile 4-5 (HR, 6.35; 95% CI, 3.51-11.5) patients. Hospitalization rates for HF were 4-fold higher among INTERMACS profile 7 (38 per 100 patient-years; rate ratio [RR] vs. Stage C: 3.88; 95% CI, 2.70-5.35), 6-fold higher among profile 6 patients (54 per 100 patient-years; RR, 5.69; 95% CI, 3.72-8.71), and 10-fold higher among profile 4-5 patients (69 per 100 patient-years; RR, 9.96; 95% CI, 5.15-19.3) than stable Stage C patients (11 per 100 patient-years). All-cause hospitalization rates had similar trends. INTERMACS profiles offered better prognostic separation than New York Heart Association functional classifications.
Conclusions:
The study authors concluded that INTERMACS profiles strongly predict subsequent mortality and hospitalization burden in non–inotrope-dependent outpatients with HFrEF and could therefore facilitate and promote advanced HF awareness among clinicians and planning for advanced HF therapies.
Perspective:
This single-center retrospective study suggests that INTERMACS profile may be an important predictor of morbidity and mortality in systolic HF patients. Prospective multicenter studies are needed to validate these important findings.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Chronic Heart Failure, Heart Transplant, Mechanical Circulatory Support
Keywords: Cardiac Surgical Procedures, Geriatrics, Heart Failure, Heart Failure, Systolic, Heart Transplantation, Heart-Assist Devices, Outcome Assessment, Health Care, Outpatients, Stroke Volume
< Back to Listings
