Author + information
- Received February 21, 2018
- Accepted March 27, 2018
- Published online August 9, 2018.
- Ayman Samman-Tahhan, MDa,
- Jeffrey S. Hedley, MD, MScb,
- Andrew A. McCue, MDa,
- Jonathan B. Bjork, MDc,
- Vasiliki V. Georgiopoulou, MD, MPH, PhDa,
- Alanna A. Morris, MD, MSca,
- Javed Butler, MD, MPH, MBAd and
- Andreas P. Kalogeropoulos, MD, MPH, PhDd,∗ ()
- aDivision of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- bDepartment of Cardiology, Cleveland Clinic, Cleveland, Ohio
- cDepartment of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- dDivision of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York
- ↵∗Address for correspondence:
Dr. Andreas Kalogeropoulos, Stony Brook University Medical Center, Stony Brook University, Health Sciences Center, T-16, Room 080, 101 Nicolls Road, Stony Brook, New York 11794-8167.
Objectives This study sought to evaluate INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles for prognostic use among ambulatory non–inotrope-dependent patients with heart failure with reduced ejection fraction (HFrEF).
Background Data for INTERMACS profiles and prognoses in ambulatory patients with HFrEF are limited.
Methods We evaluated 3-year outcomes in 969 non–inotrope-dependent outpatients with HFrEF (EF: ≤40%) not previously receiving advanced HF therapies. Patients meeting an INTERMACS profile at baseline were classified as profile 7 (n = 348 [34.7%]); 146 patients (14.5%) were classified profile 6; and 52 patients (5.2%) were classified profile 4 to 5. Remaining patients were classified “stable Stage C” (n = 423 [42.1%]).
Results Three-year mortality rate was 10.0% among stable Stage C patients compared with 21.8% among INTERMACS profile 7 (hazard ratio [HR] vs. Stage C: 2.45; 95% confidence interval [CI]: 1.64 to 3.66), 26.0% among profile 6 (HR: 3.93; 95% CI: 1.64 to 3.66), and 43.8% among profile 4 to 5 (HR 6.35; 95% CI: 3.51 to 11.5) patients. Hospitalization rates for HF were 4-fold higher among INTERMACS profile 7 (38 per 100 patient-years; rate ratio [RR] vs. Stage C: 3.88; 95% CI: 2.70 to 5.35), 6-fold higher among profile 6 patients (54 per 100 patient-years; RR: 5.69; 95% CI: 3.72 to 8.71), and 10-fold higher among profile 4 to 5 patients (69 per 100 patient-years; RR: 9.96; 95% CI: 5.15 to 19.3) than stable Stage C patients (11 per 100 patient-years). All-cause hospitalization rates had similar trends. INTERMACS profiles offered better prognostic separation than NYHA functional classifications.
Conclusions INTERMACS profiles strongly predict subsequent mortality and hospitalization burden in non–inotrope-dependent outpatients with HFrEF. These simple profiles could therefore facilitate and promote advanced HF awareness among clinicians and planning for advanced HF therapies.
Dr. Butler has consulted for Amgen, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squib, CVRx, G3 Pharmacautical, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. All other authors have reported that they have no relationships with industry relevant to the contents of this paper to disclose.
- Received February 21, 2018.
- Accepted March 27, 2018.
- 2018 American College of Cardiology Foundation
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