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Defining Ambulatory Advanced Heart Failure: MedaMACS and Beyond

Current Heart Failure Reports volume 14, pages 498–506 (2017)Cite this article

Abstract

Purpose of Review

Extended survival with LVADs has generated interest in implantation for ambulatory patients with advanced heart failure (HF) prior to dependence on inotropes, though we remain limited in our ability to define and advance indications in this less sick advanced HF population.

Recent Findings

The MedaMACS and ROADMAP studies have informed prognosis and decision-making for ambulatory patients with advanced HF. Sicker INTERMACS profiles are consistently associated with high risk of death or rescue LVAD. Appropriately selected patients in profile 4 should be considered for LVADs based on their high mortality and poor quality of life. These studies also shed light on discordant perceptions of HF disease severity between patients and their physicians.

Summary

For ambulatory patients with HF not at imminent risk of death, shared decision-making about LVAD requires measured and individualized consideration of risk and benefit beyond survival. Future studies, including the ongoing REVIVAL study, should provide additional prognostic information in this patient population and should aid patients, caregivers, and physicians as they contemplate complex decisions regarding LVAD therapy.

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Fig. 1

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Acknowledgements

The authors thank Dr. Lynne W. Stevenson for the encouragement and formation of the MedaMACS Registry collaboration. Dr. Stewart thanks the Kenneth L. Baughman Master Clinician Scholar Program in Cardiovascular Medicine at Brigham and Women’s Hospital for its support.

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Affiliations

  1. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Garrick C. Stewart

  2. Division of Cardiology, University of Colorado, Aurora, CO, USA

    Amrut V. Ambardekar

  3. Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Michelle M. Kittleson

Authors
  1. Garrick C. Stewart
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  2. Amrut V. Ambardekar
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  3. Michelle M. Kittleson
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Corresponding author

Correspondence to Garrick C. Stewart.

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Conflict of Interest

Garrick C. Stewart, Amrut V. Ambardekar, and Michelle M. Kittleson are investigators in the MedaMACS and REVIVAL registries of ambulatory advanced HF.

Garrick C. Stewart reports support from the National Heart Lung and Blood Institute for work related to this topic.

Amrut V. Ambardekar and Michelle M. Kittleson declare no other conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Prevention of Heart Failure

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Stewart, G.C., Ambardekar, A.V. & Kittleson, M.M. Defining Ambulatory Advanced Heart Failure: MedaMACS and Beyond. Curr Heart Fail Rep 14, 498–506 (2017). https://doi.org/10.1007/s11897-017-0363-7

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  • DOI: https://doi.org/10.1007/s11897-017-0363-7

Keywords

  • Advanced heart failure
  • Ventricular assist device
  • Mechanical circulatory support
  • Shared decision-making