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Stratification of Destination Therapy Candidates by J-HeartMate Risk Score Among Elderly Non-Responders to Cardiac

Asami Yoshimura1, Noriko Kikuchi1, Satoshi Saito2

  • 1Department of Cardiology, Tokyo Women's Medical University Tokyo Japan.

Circulation Reports
|September 19, 2022
PubMed

Insights

The J-HeartMate Risk Score (J-HMRS) identifies elderly heart failure patients who did not respond to cardiac resynchronization therapy (CRT) as candidates for destination therapy (DT). This score helps predict prognosis and suitability for LVAD support in Japan.

Area of Science:

  • Cardiology
  • Medical Devices
  • Geriatrics

Background:

  • Destination therapy (DT) using continuous-flow left ventricular assist devices (LVADs) offers a treatment option for elderly patients with refractory heart failure (HF).
  • Elderly patients who do not respond to cardiac resynchronization therapy (CRT) have historically been limited to palliative care options.
  • DT became available in Japan in April 2021, creating a need to evaluate patient suitability.

Purpose of the Study:

  • To investigate the prognosis of elderly patients with refractory HF who are non-responders to CRT.
  • To assess the feasibility of DT for these patients using the J-HeartMate Risk Score (J-HMRS).

Main Methods:

  • Retrospective analysis of 76 elderly (65-75 years) CRT non-responders from Tokyo Women's Medical University (2000-2018).
  • Calculation of the J-HeartMate Risk Score (J-HMRS) for each patient.
  • Stratification into low, medium, and high-risk groups based on J-HMRS to analyze cardiac events and survival post-CRT.

Main Results:

  • Patients were categorized into low (n=23), medium (n=29), and high (n=24) risk groups based on J-HMRS.
  • Heart failure rehospitalizations and ventricular arrhythmia events were similar across risk groups.
  • Survival analysis indicated significantly higher survival in the low-risk J-HMRS group compared to the high-risk group (P=0.04) after CRT.

Conclusions:

  • The J-HeartMate Risk Score (J-HMRS) effectively identifies elderly CRT non-responders.
  • Approximately 30% of elderly CRT non-responders were classified as low risk by J-HMRS.
  • These low-risk patients are considered suitable candidates for destination therapy (DT) with LVADs in Japan.

Keywords:
Cardiac resynchronization therapyDestination therapyElderlyJ-HeartMate Risk ScoreLeft ventricular assist device

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