The Effect of Age on Outcomes Following Destination Therapy Left Ventricular Assist Device Implantation: An Analysis of the IMACS Registry
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PURPOSE: Destination therapy (DT) left ventricular assist device (LVAD) may be an option for patients with advanced heart failure age ≥70 who may not be otherwise eligible for heart transplantation. Outcomes post-LVAD in older populations have been variable. The objectives of this study were to describe survival, characterize rates of adverse events (AEs) and compare survival after an AE in patients age ≥70 vs. age 50-69. METHODS: A retrospective analysis was conducted using the ISHLT Mechanically Assisted Circulatory Support (IMACS) registry. All adults ≥50 years old implanted with a continuous flow LVAD as DT between 2013-2017 were included. The primary outcome was all-cause mortality after LVAD. The secondary outcomes were the incidence of and survival after the following AEs: gastrointestinal (GI) bleeding, infection, stroke, pump thrombosis, pump exchange and right-sided heart failure. All-cause mortality and AEs were assessed using competing risk models. RESULTS: A total of 5,572 patients (81% male, 52% ischemic cardiomyopathy) were included: 3,700 (66%) age 50-69 and 1,872 (34%) age ≥70. All-cause mortality in patients age ≥70 was 55.8% by 42 months compared to 44.8% in patients age 50-69 (p=0.001, Figure). Patients age ≥70 had a 29.5% higher risk of death after LVAD than patients age 50-69 (HR 1.295 [95% CI 1.184-1.416], p<0.001). GI bleeding occurred significantly more often in patients age ≥70 and was associated with an increased risk of death. The incidence of stroke and infection was similar between age groups. Experiencing any AE increased mortality risk, however the increase in mortality risk associated with an AE did not vary with age. CONCLUSION: Older patients have reduced survival post-DT LVAD which is primarily accounted for by increased rates of GI bleeding. Careful patient selection beyond age alone may allow for optimal outcomes following DT LVAD and an informed consent discussion with regards to treatment options in patients age ≥70.
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