Left ventricular assist device patient selection: do risk scores help?

Area of Science:

• Cardiology and Mechanical Circulatory Support

Background:

• Mechanical circulatory support (MCS) and left ventricular assist device (LVAD) are increasingly used for advanced heart failure (HF).
• Effective patient selection is critical, as less ill patients tend to achieve better outcomes with these devices.

Purpose of the Study:

• To review the evolution and utility of risk scores and classification schemes in MCS and LVAD patient selection.
• To discuss the implications of these tools for informed consent and shared decision-making in advanced heart failure management.

Main Methods:

• Review of existing risk models and classification schemes for MCS and LVAD therapy.
• Analysis of the focus of current models, particularly concerning short-term mortality versus long-term survival and quality of life.

Main Results:

• Risk scores and classification schemes have been developed to structure medical decision-making for MCS and LVAD implantation.
• Many existing models primarily focus on short-term mortality, potentially overlooking long-term survival and quality of life considerations.

Conclusions:

• Continuous refinement of risk assessment tools is necessary as MCS technology and clinical experience advance.
• A comprehensive approach is needed to evaluate the benefits and pitfalls of risk models for optimal patient selection in advanced heart failure.