Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy

A subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure)

Lynne Warner Stevenson, Leslie W. Miller, Patrice Desvigne-Nickens, Deborah D. Ascheim, Michael K. Parides, Dale G. Renlund, Ronald M. Oren, Steven K. Krueger, Maria Rosa Costanzo, L. Samuel Wann, Ronald G. Levitan, Donna Mancini

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

Background-Left ventricular assist devices (LVADs) have improved survival in patients with end-stage heart failure. Compared with previous trials, the Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial enrolled patients with more advanced heart failure and high prevalence of intravenous inotropic therapy. This study analyzes, on a post hoc basis, outcomes in patients undergoing inotropic infusions at randomization. Methods and Results-Of 129 patients randomized, 91 were receiving intravenous inotropic therapy at randomization to LVAD or optimal medical management (OMM). Mean systolic pressure was 100 versus 107 mm Hg in those not receiving inotropes, serum sodium was 134 versus 137 mEq/L, and left ventricular ejection fraction was 17% for both groups. LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMM group, respectively, 6-month survival was 60% versus 39%, 1-year survival rates were 49% versus 24%, and 2-year survival rates were 28% versus 11%. For 38 patients not undergoing inotropic infusions, 6-month survival was 61% for those with LVADs and 67% for those with OMM, whereas 1-year rates were 57% and 40%, respectively (P=0.55). Quality-of-life scores for survivors improved. Median days out of hospital for patients on inotropic therapy at randomization were 255 with LVAD and 105 with OMM. Conclusions-Despite severe compromise, patients undergoing inotropic infusions at randomization derived major LVAD survival benefit with improved quality of life. Patients not undergoing inotropic infusions had higher survival rates both with and without LVAD, but differences did not reach significance. Future studies should prespecify analyses of inotropic and other therapies to determine how disease severity and parallel medical treatment influence the benefits offered by mechanical circulatory support.

Original languageEnglish (US)
Pages (from-to)975-981
Number of pages7
JournalCirculation
Volume110
Issue number8
DOIs
StatePublished - Aug 24 2004
Externally publishedYes

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Heart-Assist Devices
Heart Failure
Random Allocation
Survival
Therapeutics
Survival Rate
Quality of Life
Stroke Volume
Survivors
Sodium
Blood Pressure

Keywords

  • Heart failure
  • Heart-assist device
  • Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy : A subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). / Stevenson, Lynne Warner; Miller, Leslie W.; Desvigne-Nickens, Patrice; Ascheim, Deborah D.; Parides, Michael K.; Renlund, Dale G.; Oren, Ronald M.; Krueger, Steven K.; Costanzo, Maria Rosa; Wann, L. Samuel; Levitan, Ronald G.; Mancini, Donna.

In: Circulation, Vol. 110, No. 8, 24.08.2004, p. 975-981.

Research output: Contribution to journalArticle

Stevenson, Lynne Warner ; Miller, Leslie W. ; Desvigne-Nickens, Patrice ; Ascheim, Deborah D. ; Parides, Michael K. ; Renlund, Dale G. ; Oren, Ronald M. ; Krueger, Steven K. ; Costanzo, Maria Rosa ; Wann, L. Samuel ; Levitan, Ronald G. ; Mancini, Donna. / Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy : A subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). In: Circulation. 2004 ; Vol. 110, No. 8. pp. 975-981.
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abstract = "Background-Left ventricular assist devices (LVADs) have improved survival in patients with end-stage heart failure. Compared with previous trials, the Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial enrolled patients with more advanced heart failure and high prevalence of intravenous inotropic therapy. This study analyzes, on a post hoc basis, outcomes in patients undergoing inotropic infusions at randomization. Methods and Results-Of 129 patients randomized, 91 were receiving intravenous inotropic therapy at randomization to LVAD or optimal medical management (OMM). Mean systolic pressure was 100 versus 107 mm Hg in those not receiving inotropes, serum sodium was 134 versus 137 mEq/L, and left ventricular ejection fraction was 17{\%} for both groups. LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMM group, respectively, 6-month survival was 60{\%} versus 39{\%}, 1-year survival rates were 49{\%} versus 24{\%}, and 2-year survival rates were 28{\%} versus 11{\%}. For 38 patients not undergoing inotropic infusions, 6-month survival was 61{\%} for those with LVADs and 67{\%} for those with OMM, whereas 1-year rates were 57{\%} and 40{\%}, respectively (P=0.55). Quality-of-life scores for survivors improved. Median days out of hospital for patients on inotropic therapy at randomization were 255 with LVAD and 105 with OMM. Conclusions-Despite severe compromise, patients undergoing inotropic infusions at randomization derived major LVAD survival benefit with improved quality of life. Patients not undergoing inotropic infusions had higher survival rates both with and without LVAD, but differences did not reach significance. Future studies should prespecify analyses of inotropic and other therapies to determine how disease severity and parallel medical treatment influence the benefits offered by mechanical circulatory support.",
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T1 - Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy

T2 - A subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure)

AU - Stevenson, Lynne Warner

AU - Miller, Leslie W.

AU - Desvigne-Nickens, Patrice

AU - Ascheim, Deborah D.

AU - Parides, Michael K.

AU - Renlund, Dale G.

AU - Oren, Ronald M.

AU - Krueger, Steven K.

AU - Costanzo, Maria Rosa

AU - Wann, L. Samuel

AU - Levitan, Ronald G.

AU - Mancini, Donna

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N2 - Background-Left ventricular assist devices (LVADs) have improved survival in patients with end-stage heart failure. Compared with previous trials, the Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial enrolled patients with more advanced heart failure and high prevalence of intravenous inotropic therapy. This study analyzes, on a post hoc basis, outcomes in patients undergoing inotropic infusions at randomization. Methods and Results-Of 129 patients randomized, 91 were receiving intravenous inotropic therapy at randomization to LVAD or optimal medical management (OMM). Mean systolic pressure was 100 versus 107 mm Hg in those not receiving inotropes, serum sodium was 134 versus 137 mEq/L, and left ventricular ejection fraction was 17% for both groups. LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMM group, respectively, 6-month survival was 60% versus 39%, 1-year survival rates were 49% versus 24%, and 2-year survival rates were 28% versus 11%. For 38 patients not undergoing inotropic infusions, 6-month survival was 61% for those with LVADs and 67% for those with OMM, whereas 1-year rates were 57% and 40%, respectively (P=0.55). Quality-of-life scores for survivors improved. Median days out of hospital for patients on inotropic therapy at randomization were 255 with LVAD and 105 with OMM. Conclusions-Despite severe compromise, patients undergoing inotropic infusions at randomization derived major LVAD survival benefit with improved quality of life. Patients not undergoing inotropic infusions had higher survival rates both with and without LVAD, but differences did not reach significance. Future studies should prespecify analyses of inotropic and other therapies to determine how disease severity and parallel medical treatment influence the benefits offered by mechanical circulatory support.

AB - Background-Left ventricular assist devices (LVADs) have improved survival in patients with end-stage heart failure. Compared with previous trials, the Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial enrolled patients with more advanced heart failure and high prevalence of intravenous inotropic therapy. This study analyzes, on a post hoc basis, outcomes in patients undergoing inotropic infusions at randomization. Methods and Results-Of 129 patients randomized, 91 were receiving intravenous inotropic therapy at randomization to LVAD or optimal medical management (OMM). Mean systolic pressure was 100 versus 107 mm Hg in those not receiving inotropes, serum sodium was 134 versus 137 mEq/L, and left ventricular ejection fraction was 17% for both groups. LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMM group, respectively, 6-month survival was 60% versus 39%, 1-year survival rates were 49% versus 24%, and 2-year survival rates were 28% versus 11%. For 38 patients not undergoing inotropic infusions, 6-month survival was 61% for those with LVADs and 67% for those with OMM, whereas 1-year rates were 57% and 40%, respectively (P=0.55). Quality-of-life scores for survivors improved. Median days out of hospital for patients on inotropic therapy at randomization were 255 with LVAD and 105 with OMM. Conclusions-Despite severe compromise, patients undergoing inotropic infusions at randomization derived major LVAD survival benefit with improved quality of life. Patients not undergoing inotropic infusions had higher survival rates both with and without LVAD, but differences did not reach significance. Future studies should prespecify analyses of inotropic and other therapies to determine how disease severity and parallel medical treatment influence the benefits offered by mechanical circulatory support.

KW - Heart failure

KW - Heart-assist device

KW - Transplantation

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