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How does age affect outcomes after left ventricular assist device implantation : results from the PCHF-VAD registry

Radhoe, Sumant P. ; Veenis, Jesse F. ; Jakus, Nina ; Timmermans, Philippe ; Pouleur, Anne Catherine ; Rubís, Pawel ; Van Craenenbroeck, Emeline M. ; Gaizauskas, Edvinas ; Barge-Caballero, Eduardo and Paolillo, Stefania , et al. (2023) In ESC Heart Failure 10(2). p.884-894
Abstract

Aims: Use of left ventricular assist devices (LVADs) in older patients has increased, and assessing outcomes in older LVAD recipients is important. Therefore, this study aimed to investigate associations between age and outcomes after continuous-flow LVAD (cf-LVAD) implantation. Methods and results: Cf-LVAD patients from the multicentre European PCHF-VAD registry were included and categorized into those <50, 50–64, and ≥65 years old. The primary endpoint was all-cause mortality. Among secondary outcomes were heart failure (HF) hospitalizations, right ventricular (RV) failure, haemocompatibility score, bleeding events, non-fatal thromboembolic events, and device-related infections. Of 562 patients, 184 (32.7%) were <50, 305 (54.3%)... (More)

Aims: Use of left ventricular assist devices (LVADs) in older patients has increased, and assessing outcomes in older LVAD recipients is important. Therefore, this study aimed to investigate associations between age and outcomes after continuous-flow LVAD (cf-LVAD) implantation. Methods and results: Cf-LVAD patients from the multicentre European PCHF-VAD registry were included and categorized into those <50, 50–64, and ≥65 years old. The primary endpoint was all-cause mortality. Among secondary outcomes were heart failure (HF) hospitalizations, right ventricular (RV) failure, haemocompatibility score, bleeding events, non-fatal thromboembolic events, and device-related infections. Of 562 patients, 184 (32.7%) were <50, 305 (54.3%) were aged 50–64, whereas 73 (13.0%) were ≥65 years old. Median follow-up was 1.1 years. Patients in the oldest age group were significantly more often designated as destination therapy (DT) candidates (61%). A 10 year increase in age was associated with a significantly higher risk of mortality (hazard ratio [HR] 1.34, 95% confidence interval [CI] [1.15–1.57]), intracranial bleeding (HR 1.49, 95% CI [1.10–2.02]), and non-intracranial bleeding (HR 1.30, 95% CI [1.09–1.56]), which was confirmed by a higher mean haemocompatibility score (1.37 vs. 0.77, oldest vs. youngest groups, respectively, P = 0.033). Older patients suffered from less device-related infections requiring systemic antibiotics. No age-related differences were observed in HF-related hospitalizations, ventricular arrhythmias, pump thrombosis, non-fatal thromboembolic events, or RV failure. Conclusions: In the PCHF-VAD registry, higher age was associated with increased risk of mortality, and especially with increased risk of major bleeding, which is particularly relevant for the DT population. The risks of HF hospitalizations, pump thrombosis, ventricular arrhythmia, or RV failure were comparable. Strikingly, older patients had less device-related infections.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Advanced heart failure, Age, Destination therapy, Left ventricular assist devices, Survival
in
ESC Heart Failure
volume
10
issue
2
pages
884 - 894
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:36460627
  • scopus:85143140697
ISSN
2055-5822
DOI
10.1002/ehf2.14247
language
English
LU publication?
yes
id
4be488c0-f53a-4955-be6a-4d7233826d65
date added to LUP
2023-01-30 14:57:27
date last changed
2024-04-14 06:19:33
@article{4be488c0-f53a-4955-be6a-4d7233826d65,
  abstract     = {{<p>Aims: Use of left ventricular assist devices (LVADs) in older patients has increased, and assessing outcomes in older LVAD recipients is important. Therefore, this study aimed to investigate associations between age and outcomes after continuous-flow LVAD (cf-LVAD) implantation. Methods and results: Cf-LVAD patients from the multicentre European PCHF-VAD registry were included and categorized into those &lt;50, 50–64, and ≥65 years old. The primary endpoint was all-cause mortality. Among secondary outcomes were heart failure (HF) hospitalizations, right ventricular (RV) failure, haemocompatibility score, bleeding events, non-fatal thromboembolic events, and device-related infections. Of 562 patients, 184 (32.7%) were &lt;50, 305 (54.3%) were aged 50–64, whereas 73 (13.0%) were ≥65 years old. Median follow-up was 1.1 years. Patients in the oldest age group were significantly more often designated as destination therapy (DT) candidates (61%). A 10 year increase in age was associated with a significantly higher risk of mortality (hazard ratio [HR] 1.34, 95% confidence interval [CI] [1.15–1.57]), intracranial bleeding (HR 1.49, 95% CI [1.10–2.02]), and non-intracranial bleeding (HR 1.30, 95% CI [1.09–1.56]), which was confirmed by a higher mean haemocompatibility score (1.37 vs. 0.77, oldest vs. youngest groups, respectively, P = 0.033). Older patients suffered from less device-related infections requiring systemic antibiotics. No age-related differences were observed in HF-related hospitalizations, ventricular arrhythmias, pump thrombosis, non-fatal thromboembolic events, or RV failure. Conclusions: In the PCHF-VAD registry, higher age was associated with increased risk of mortality, and especially with increased risk of major bleeding, which is particularly relevant for the DT population. The risks of HF hospitalizations, pump thrombosis, ventricular arrhythmia, or RV failure were comparable. Strikingly, older patients had less device-related infections.</p>}},
  author       = {{Radhoe, Sumant P. and Veenis, Jesse F. and Jakus, Nina and Timmermans, Philippe and Pouleur, Anne Catherine and Rubís, Pawel and Van Craenenbroeck, Emeline M. and Gaizauskas, Edvinas and Barge-Caballero, Eduardo and Paolillo, Stefania and Grundmann, Sebastian and D'Amario, Domenico and Braun, Oscar and Gkouziouta, Aggeliki and Planinc, Ivo and Samardzic, Jure and Meyns, Bart and Droogne, Walter and Wierzbicki, Karol and Holcman, Katarzyna and Flammer, Andreas J. and Gasparovic, Hrvoje and Biocina, Bojan and Lund, Lars H. and Milicic, Davor and Ruschitzka, Frank and Cikes, Maja and Brugts, Jasper J.}},
  issn         = {{2055-5822}},
  keywords     = {{Advanced heart failure; Age; Destination therapy; Left ventricular assist devices; Survival}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{884--894}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{ESC Heart Failure}},
  title        = {{How does age affect outcomes after left ventricular assist device implantation : results from the PCHF-VAD registry}},
  url          = {{http://dx.doi.org/10.1002/ehf2.14247}},
  doi          = {{10.1002/ehf2.14247}},
  volume       = {{10}},
  year         = {{2023}},
}