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Risk Stratification of Patients With Current Generation Continuous-Flow Left Ventricular Assist Devices Being Bridged
Insights
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.
Abstract:
Patients bridged to transplant (BTT) with continuous-flow left ventricular assist devices (CF-LVADs) have increased in the past decade. Decision support tools for these patients are limited. We developed a risk score to estimate prognosis and guide decision-making. We included heart transplant recipients bridged with CF-LVADs from the United Network for Organ Sharing (UNOS) database and divided them into development (2,522 patients) and validation cohorts (1,681 patients). Univariate and multivariate Cox proportional hazards models were performed. Variables that independently predicted outcomes (age, African American race, recipient body mass index [BMI], intravenous [IV] antibiotic use, pretransplant dialysis, and total bilirubin) were assigned weight using linear transformation, and risk scores were derived. Patients were grouped by predicted posttransplant mortality: low risk (≤ 38 points), medium risk (38-41 points), and high risk (≥ 42 points). We performed Cox proportional hazards analysis on wait-listed CF-LVAD patients who were not transplanted. Score significantly discriminated survival among the groups in the development cohort (6.7, 12.9, 20.7; p = 0.001), validation cohort (6.4, 10.1, 13.6; p < 0.001), and ambulatory cohort (6.4, 11.5, 17.2; p < 0.001). We derived a left ventricular assist device (LVAD) BTT risk score that effectively identifies CF-LVAD patients who are at higher risk for worse outcomes after heart transplant. This score may help physicians weigh the risks of transplantation in patients with CF-LVAD.
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