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Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
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INTERMACS: interval analysis of registry data.

William L Holman1, Walter E Pae, Jeffrey J Teutenberg

  • 1Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA. wholman@uab.edu

Journal of the American College of Surgeons
|May 30, 2009
PubMed
Summary
This summary is machine-generated.

Timely referral for mechanical circulatory support devices (MCSDs) is crucial for heart failure patients. Early intervention before critical cardiogenic shock significantly impacts survival outcomes in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database.

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Area of Science:

  • Cardiology and Cardiovascular Surgery
  • Biomedical Engineering
  • Clinical Research and Data Analysis

Background:

  • The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) is an NIH-sponsored registry collecting data on US FDA-approved mechanical circulatory support devices (MCSDs).
  • MCSDs are utilized for destination therapy, bridge to transplantation (BTT), or as a bridge to recovery for patients with advanced heart failure.
  • Data analysis was performed on INTERMACS participants through March 31, 2008.

Purpose of the Study:

  • To analyze data from the INTERMACS registry to identify patient characteristics and outcomes associated with mechanical circulatory support devices.
  • To determine risk factors for death and transplantation in patients receiving MCSDs.
  • To evaluate the influence of preimplantation patient condition and device configuration on survival.

Main Methods:

  • Analysis of prospectively collected data from 483 patients enrolled across 94 sites in the INTERMACS registry.
  • Variables included demographics, patient outcomes (survival, adverse events), hemodynamic data, and laboratory values.
  • Competing outcomes methods were employed to analyze risk factors for death and transplantation.

Main Results:

  • At 6 months postimplantation, 42% of patients were ongoing support, 33% received cardiac transplantation, 3% experienced cardiac recovery, and 22% died.
  • Common causes of death included central nervous system events (11%), cardiovascular failure (8%), and respiratory failure (8%).
  • Patient condition at implantation (critical cardiogenic shock vs. others) and device configuration (LVAD vs. BiVAD) significantly influenced survival (p=0.007 and p<0.0001, respectively).

Conclusions:

  • INTERMACS demonstrates increasing participation, highlighting its growing importance in tracking MCSD use.
  • Preimplantation patient status, particularly avoiding critical cardiogenic shock, is a key determinant of survival, emphasizing the need for timely referral.
  • As more MCSDs gain FDA approval, the INTERMACS registry will be instrumental in comparative device analysis and guiding clinical practice.