INTERMACS Profiles and Outcomes Among Non-Inotrope-Dependent Outpatients With Heart Failure and Reduced Ejection Fraction

Ayman Samman-Tahhan; Jeffrey S Hedley; Andrew A McCue; Jonathan B Bjork; Vasiliki V Georgiopoulou; Alanna A Morris; Javed Butler; Andreas P Kalogeropoulos

doi:10.1016/j.jchf.2018.03.018

INTERMACS Profiles and Outcomes Among Non-Inotrope-Dependent Outpatients With Heart Failure and Reduced Ejection Fraction

JACC Heart Fail. 2018 Sep;6(9):743-753. doi: 10.1016/j.jchf.2018.03.018. Epub 2018 Aug 8.

Authors

Ayman Samman-Tahhan¹, Jeffrey S Hedley², Andrew A McCue¹, Jonathan B Bjork³, Vasiliki V Georgiopoulou¹, Alanna A Morris¹, Javed Butler⁴, Andreas P Kalogeropoulos⁵

Affiliations

¹ Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
² Department of Cardiology, Cleveland Clinic, Cleveland, Ohio.
³ Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
⁴ Division of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
⁵ Division of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York. Electronic address: andreas.kalogeropoulos@stonybrook.edu.

PMID: 30098970
DOI: 10.1016/j.jchf.2018.03.018

Abstract

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.

Keywords: HFrEF; INTERMACS; heart failure; heart failure with reduced ejection fraction; outcomes.

MeSH terms

Aged
Ambulatory Care
Cardiotonic Agents
Cause of Death
Female
Heart Failure / physiopathology*
Heart Failure / therapy
Heart Transplantation / statistics & numerical data
Heart-Assist Devices
Hospitalization / statistics & numerical data*
Humans
Male
Middle Aged
Mortality*
Prognosis
Proportional Hazards Models
Prosthesis Implantation / statistics & numerical data
Risk Assessment
Stroke Volume*

Substances

Cardiotonic Agents