Painting profiles of ambulatory advanced heart failure: A report from the revival registry

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Purpose: Ambulatory patients with advanced heartfailure (HF) are increasingly being considered for mechanical circulatory support. INTERMACS patient profiles are a commonly used short-hand for HF disease severity and describe clinical trajectory, but have not been validated for use in ambulatorypatients on oral medical therapy. Methods: REVIVAL, a prospective, observational study, enrolled 400 outpatients from 21 VAD/transplant centers in 2015-16. Subjects had NYHA Class II-IV systolic HF despite optimal medical and electrical therapies, as well as arecent HF hospitalization, transplant listing, functional limitation, or evidence of high neurohormonal activation. Exclusion criteria included inotropes, dialysis or creatinine > 3mg/dL, or a non-cardiac disease limiting function or survival. Baseline characteristics, medications, and laboratories were evaluated according to INTERMACS profile assigned at enrollment by thetreating physician. Continuous data were compared by one way ANOVA or Wilcoxon rank sum, categorical data using Chi-square test. Results: Across INTERMACS patient profiles 4-7, there was no difference in age, gender, race, ejection fraction, blood pressure, jugular venous pressure, use ofguideline-directed medical therapy, or most laboratories. However, lower INTERMACS profile was associated with progressively shorter 6-minute walk distance, higher uric acid level, and higher anticipated mortality by the Seattle HF Model Score. (TABLE) Conclusion: Among ambulatory patients with advanced HF, lower INTERMACS profile was associated with increased disease severity as reflected by greater functional limitation and higher anticipated mortality. INTERMACS profiling is aconvenient short-hand that encapsulates relevant prognostic information across multiple clinical domains. These profiles may assist in identifying ambulatory patients for consideration of advancedor investigational therapies (Table presented).





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