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The HeartMate Risk Score Identifies Patients With Similar Mortality Risk Across All INTERMACS Profiles in
Luigi Adamo1, Yuanyuan Tang2, Michael E Nassif3
1Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Insights
The HeartMate Risk Score (HMRS) effectively stratifies risk for left ventricular assist device (LVAD) recipients across all disease severity levels. This score may be more accurate than INTERMACS profiles for predicting mortality in mechanical circulatory support patients.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- The HeartMate Risk Score (HMRS) was developed for risk stratification in left ventricular assist device (LVAD) recipients.
- Previous studies have questioned the HMRS's validity, necessitating further investigation in diverse patient populations.
Purpose of the Study:
- To evaluate the performance of the HMRS in a large, multicenter cohort of LVAD recipients.
- To specifically assess HMRS performance across different levels of disease severity, defined by INTERMACS profiles.
Main Methods:
- A retrospective analysis of the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database.
- Calculation of HMRS for 10,847 LVAD patients and assessment of its association with mortality using Cox models.
- Examination of HMRS performance stratified by INTERMACS profiles (1, 2, 3, and ≥4).
Main Results:
- The HMRS demonstrated moderate discrimination for both short-term (90-day C-index 0.62) and long-term (2-year C-index 0.60) mortality.
- Higher HMRS scores were significantly associated with increased 90-day mortality risk (relative risk 2.8).
- The predictive value of HMRS was consistent across all INTERMACS profiles, with some lower-profile patients showing similar or lower mortality than higher-profile patients.
Conclusions:
- The HMRS is a valid tool for risk stratification in LVAD patients, irrespective of INTERMACS profile.
- HMRS may offer superior risk assessment compared to traditional INTERMACS classification alone.
- The wide spectrum of mortality risk within INTERMACS profiles highlights the utility of HMRS and suggests low INTERMACS profiles should not preclude mechanical support.
Objectives:
This study sought to assess the performance of the HeartMate Risk Score (HMRS) in a large multicenter cohort, with a focus on its performance as a function of disease severity.
Background:
The HMRS has been proposed as a simple tool for risk stratification of LVAD recipients, but subsequent studies have challenged its validity.
Methods:
We performed a retrospective, longitudinal, comparative study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The HMRS was calculated for each patient and its association with mortality was assessed using Cox models, including a pre-specified interaction by INTERMACS profile groups (1 vs. 2 vs. 3 vs 4+).
Results:
Among 10,847 patients with a mean age of 57.0 ± 12.9 years, 78.9 % were male; and 14.1%, 37.4%, 30.4%, and 18.2% were in INTERMACS profile groups 1, 2, 3, and ≥4, respectively. The HMRS showed moderate discrimination for both short-term (90-day, C-index 0.62) and long-term (2-years, C-index 0.60) mortality, with no significant difference between axial and centrifugal devices. Patients in the highest HMRS group had a relative risk of 90-day mortality 2.8 times greater than those in the lowest HMRS group (13.0% vs. 4.7%; p < 0.001). Importantly, the relative risks of higher HMRS scores were similar across INTERMACS profile groups, with subgroups of patients in INTERMACS profile 1 and 2 having comparable or lower mortality than some in INTERMACS profile 4+.
Conclusions:
The HMRS is a valid means of risk-stratifying patients across all INTERMACS profiles and may be superior to traditional INTERMACS classification. Risk stratification with the HMRS showed that patients within each INTERMACS profile groups have a wide spectrum of mortality risk and low INTERMACS profiles should therefore not be considered a contraindication to mechanical support.
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