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Risk Stratification of Patients With Current Generation Continuous-Flow Left Ventricular Assist Devices Being Bridged
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|September 9, 2017
Summary
A new risk score helps predict outcomes for heart transplant patients on continuous-flow left ventricular assist devices (CF-LVADs). This tool aids in decision-making for patients bridged to transplant (BTT).
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Informatics
Background:
- Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used for patients bridged to transplant (BTT).
- Limited decision support tools exist for managing CF-LVAD patients awaiting heart transplantation.
- Accurate prognosis estimation is crucial for guiding transplantation decisions in this population.
Purpose of the Study:
- To develop and validate a risk score for predicting post-transplant outcomes in CF-LVAD patients.
- To provide a tool that aids physicians in decision-making for heart transplant candidates on CF-LVADs.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database, including heart transplant recipients bridged with CF-LVADs.
- Divided patients into development (2,522) and validation (1,681) cohorts.
- Employed Cox proportional hazards models to identify independent predictors (age, race, BMI, IV antibiotics, dialysis, bilirubin) and derived a risk score.
Main Results:
- The derived LVAD BTT risk score effectively discriminated survival across low, medium, and high-risk groups in both development and validation cohorts.
- Significant differences in outcomes were observed among risk groups (p < 0.001).
- The score also showed discrimination in wait-listed CF-LVAD patients not transplanted.
Conclusions:
- A novel LVAD BTT risk score accurately identifies CF-LVAD patients at higher risk for adverse outcomes post-heart transplant.
- This risk score can assist clinicians in evaluating transplantation risks for patients supported by CF-LVADs.
- Improved risk stratification may optimize patient selection and management in heart transplantation.
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