Predicting survival in patients receiving continuous flow left ventricular assist devices: The Heartmate II risk score

Jennifer Cowger, Kartik Sundareswaran, Joseph G. Rogers, Soon J. Park, Francis D. Pagani, Geetha Bhat, Brian Jaski, David J. Farrar, Mark S. Slaughter

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187 Scopus citations

Abstract

Objectives: The aim of this study was to derive and validate a model to predict survival in candidates for HeartMate II (HMII) (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) support. Background: LVAD mortality risk prediction is important for candidate selection and communicating expectations to patients and clinicians. With the evolution of LVAD support, prior risk prediction models have become less valid. Methods: Patients enrolled into the HMII bridge to transplantation and destination therapy trials (N = 1,122) were randomly divided into derivation (DC) (n = 583) and validation cohorts (VC) (n = 539). Pre-operative candidate predictors of 90-day mortality were examined in the DC with logistic regression, from which the HMII Risk Score (HMRS) was derived. The HMRS was then applied to the VC. Results: There were 149 (13%) deaths within 90 days. In the DC, mortality (n = 80) was higher in older patients (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1 to 1.7 per 10 years), those with greater hypoalbuminemia (OR: 0.49, 95% CI: 0.31 to 0.76 per mg/dl of albumin), renal dysfunction (OR: 2.1, 95% CI: 1.4 to 3.2 per mg/dl creatinine), coagulopathy (OR: 3.1, 95% CI: 1.7 to 5.8 per international normalized ratio unit), and in those receiving LVAD support at less experienced centers (OR: 2.2, 95% CI: 1.2 to 4.4 for <15 trial patients). Mortality in the DC low, medium, and high HMRS groups was 4%, 16%, and 29%, respectively (p < 0.001). In the VC, corresponding mortality was 8%, 11%, and 25%, respectively (p < 0.001). HMRS discrimination was good (area under the receiver-operating characteristic curve: 0.71, 95% CI: 0.66 to 0.75). Conclusions: The HMRS might be useful for mortality risk stratification in HMII candidates and may serve as an additional tool in the patient selection process.

Original languageEnglish (US)
Pages (from-to)313-321
Number of pages9
JournalJournal of the American College of Cardiology
Volume61
Issue number3
DOIs
StatePublished - Jan 22 2013

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Cowger, J., Sundareswaran, K., Rogers, J. G., Park, S. J., Pagani, F. D., Bhat, G., Jaski, B., Farrar, D. J., & Slaughter, M. S. (2013). Predicting survival in patients receiving continuous flow left ventricular assist devices: The Heartmate II risk score. Journal of the American College of Cardiology, 61(3), 313-321. https://doi.org/10.1016/j.jacc.2012.09.055