LVAD Beneficial Even For Patients With Most Severe Heart Failure
Implantation of a left ventricular assist device (LVAD) can dramatically improve the survival of patients with advanced heart failure, especially those being treated with intravenous inotropic therapy, new research suggests.
Previous reports have linked LVAD therapy with improved survival in patients with end-stage heart failure, the authors note in the August 17th rapid access issue of Circulation: Journal of the American Heart Association. Until now, however, it was unclear if this benefit applied to the sickest patients.
To investigate, Dr. Lynne Warner Stevenson, from Brigham and Women’s Hospital in Boston, and colleagues analyzed data from 129 patients enrolled in the Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial. Compared with other studies, REMATCH involved patients with more advanced heart failure and high rates of intravenous inotropic therapy.
“This is the sickest group of heart failure patients to ever enter a clinical trial,” Dr. Stevenson said in a statement. “Most had frequent and oppressive breathing difficulties and lived a bed-bound or bed-to-chair existence.”
As part of the study, the patients were randomized to receive an LVAD or optimal medical management (OMM). Of the subjects, 91 were receiving intravenous inotropic therapy at the time of randomization.
Among patients receiving inotropic therapy, LVAD placement significantly improved survival. At 1-year, the survival rates in the LVAD and OMM groups were 49% and 24%, respectively; at 2-years, the corresponding rates were 28% and 11%.
In patients not receiving inotropic therapy, the results were mixed. The OMM group experienced a slightly higher survival rate at 6 months, whereas the LVAD group experienced a slightly higher rate at 1 year. The differences were not statistically significance.
“Although the subset analysis of patients on inotropic therapy in REMATCH is the only data we currently have available, it is limited by the small numbers and it must be considered exploratory but not definitive,” Dr. Stevenson cautioned.
Circulation 2004;110.
