Ventricular Assist Device Therapy in Older Patients With Heart Failure: Characteristics and Outcomes

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• 作者：Ju H. Kim ; MDp>1p> ; Ramesh Singh ; MDp>2p> ; Francis D. Pagani ; MD ; PhDp>3p> ; Shashank S. Desai ; MDp>2p> ; Nicholas A. Haglund ; MDp>4p> ; Shannon M. Dunlay ; MD ; MSp>5p> ; Simon Maltais ; MD ; PhDp>5p> ; Keith D. Aaronson ; MD ; MSp>3p> ; John M. Stulak ; MD ; PhDp>5p> ; Mary E. Davis ; MSp>6p> ; Christopher T. Salerno ; MDp>7p> ; Jennifer A. Cowger ; MD ; MSp>7p> ; Palak Shah ; MD ; MSp>2p>p> ; p>p>palak.shah@inova.orgp> ; for the Mechanical Circulatory Support Research Network (MCSRN)
• 关键词：Geriatrics ; Heart failure ; Left ventricular assist device ; Mechanical circulatory support
• 刊名：Journal of Cardiac Failure
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：22
• 期：12
• 页码：981-987
• 全文大小：994 K
• 卷排序：22

文摘

Limited data exist on outcomes in patients ≥70 years of age supported with the use of continuous-flow left ventricular assist devices (LVADs).MethodsData on 1149 continuous-flow LVAD recipients was queried from the Mechanical Circulatory Support Research Network. Groups were assigned based on age: ≥70 years (“older patients”) and <70 years. The primary outcome was survival at one-year based on age grouping.ResultsCompared with younger patients (54.3&thinsp;&plusmn;&thinsp;11.2 y; n&thinsp;=&thinsp;986), older patients (73.4&thinsp;&plusmn;&thinsp;3.0 y) constituted only 14% of LVAD implants. Older patients had similar rates of device thrombosis (P&thinsp;=&thinsp;.47) and stroke (P&thinsp;=&thinsp;.44), but survival-free of gastrointestinal bleeding (GIB) at 1 year was lower compared with younger patients (58% vs 69%; P&thinsp;<&thinsp;.01). Unadjusted survival at 1 year in older patients was 75% compared with 84% in younger patients, and at 2 years 65% versus 73% (P&thinsp;=&thinsp;.18). Age ≥70 years was not associated with increased mortality (adjusted hazard ratio [aHR] 0.94, 95% confidence interval [CI] 0.70–1.26; P&thinsp;=&thinsp;.67). Preoperative creatinine (aHR 1.57, 95% CI: 1.30–1.89, P&thinsp;<&thinsp;.0001), bilirubin (aHR 1.22, 95% CI 1.05–1.42; P&thinsp;=&thinsp;.010), and ischemic cardiomyopathy (aHR 1.43, 95% CI 1.11–1.84; P&thinsp;=&thinsp;.005) portended increased risk of death. In older patients, the only predictor of mortality was creatinine (HR 2.1, 95% CI 1.2–3.4; P&thinsp;=&thinsp;.007). Creatinine ≥1.4&thinsp;mg/dL was associated with a 1-year survival of 65%, compared with 84% when the creatinine was <1.4&thinsp;mg/dL (P&thinsp;=&thinsp;.009).ConclusionAge >70 years is an important consideration when assessing LVAD risk, but other correlates may be more predictive of LVAD survival. Older patients without renal dysfunction have survival similar to younger patients. Older patients should be counseled about age-correlated risks, including higher rates of GIB.