April 24, 2017 – Glad to Have a VAD Across Intermacs Profiles
Most patients with continuous flow LVADs are alive after a year but it is not known how the severity of previous heart failure influences how they feel about their original decision to undergo LVAD.
INTERMACS 3.0 questionnaires include the question “If you had it all to do over again would you decide to have an LVAD knowing what you know now?” Answers to this question from patients alive on isolated LVAD after 1 year were grouped according to baseline INTERMACS profiles. Additional comparisons were made based on duration of HF and therapies received prior to LVAD implantation.
From 2012 to 2015, 4873 patients remained on continuous flow LVAD support at one year. Questionnaires were completed by 2975 (66%) patients, with non-completion most commonly explained by coordinators being too busy. The answer was yes (63.6%) or probably yes (18.7%) in 82.3% patients responding, with a similarly favorable response across all baseline INTERMACS profiles from 1 to 5 (Figure). It was not possible to compare responses for patients with prior INTERMACS profiles 6 and 7, accounting for only 34 respondents. There was no apparent impact on the Yes decision of the duration of heart failure, the number of heart failure hospitalizations, the use of continuous inotropic infusions, or the frequency of temporary support as bridge prior to LVAD implant.
Among LVAD survivors who completed questionnaires one year after implantation, most indicated that they would again choose to have a VAD after their experience with it. Although INTERMACS profile has been shown to impact survival, it did not appear to influence how many survivors at 1 year indicated satisfaction with their LVAD decision