PMID- 32585330
OWN - NLM
STAT- MEDLINE
DCOM- 20210629
LR  - 20210629
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 37
IP  - 3
DP  - 2021 Mar
TI  - The Effect of Age on Outcomes After Destination-Therapy Left Ventricular Assist 
      Device Implantation: An Analysis of the IMACS Registry.
PG  - 467-475
LID - S0828-282X(20)30573-0 [pii]
LID - 10.1016/j.cjca.2020.06.010 [doi]
AB  - BACKGROUND: As patients with advanced heart failure are living longer, defining 
      the impact of left ventricular assist devices (LVADs) on outcomes in an aging 
      population is of great importance. We describe overall survival, rates of adverse 
      events (AEs), and post-AE survival in patients age >/= 70 years vs age 50-69 years 
      after destination-therapy (DT) LVAD implantation. METHODS: A retrospective 
      analysis was conducted with the use of the International Society for Heart and 
      Lung Transplantation Mechanically Assisted Circulatory Support (IMACS) registry. 
      All adults age >/= 50 years with a continuous-flow DT LVAD from 2013 to 2017 were 
      included. The primary outcome was all-cause mortality. The secondary outcomes 
      were the incidence of and survival after gastrointestinal (GI) bleeding, 
      infection, stroke, pump thrombosis, pump exchange, and right-side heart failure. 
      Mortality and AEs were assessed with the use of competing risk models. RESULTS: 
      At total of 5,572 patients were included: 3,700 aged 50-69 and 1,872 aged >/= 70. 
      All-cause mortality by 42 months was 55.8% in patients aged >/= 70 and 44.8% in 
      patients aged 50-69 (P = 0.001). Patients aged >/= 70 had a 37.8% higher risk of 
      death after DT LVAD implantation (hazard ratio 1.378, 95% CI 1.251-1.517). 
      Patients aged >/= 70 had higher risk of GI bleeding but lower risk of right-side 
      heart failure. There was no difference between age groups for risk of infection 
      or stroke. Experiencing any AE was associated with an increased risk of death 
      that did not vary with age. CONCLUSIONS: Patients aged >/= 70 years have reduced 
      survival after DT LVAD, in part because of increased GI bleeding, while the 
      incidence of other AEs is similar to that of patients aged 50-69 years. Careful 
      patient selection beyond age alone may allow for optimal outcomes after DT LVAD 
      implantation.
CI  - Copyright (c) 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All 
      rights reserved.
FAU - Aleksova, Natasha
AU  - Aleksova N
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Alba, Ana C
AU  - Alba AC
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Fan, Chun-Po S
AU  - Fan CS
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Amin, Faizan
AU  - Amin F
AD  - McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
FAU - Kiamanesh, Omid
AU  - Kiamanesh O
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - McGuinty, Caroline
AU  - McGuinty C
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Lee, Hanna
AU  - Lee H
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Duero Posada, Juan G
AU  - Duero Posada JG
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Ross, Heather J
AU  - Ross HJ
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Billia, Filio
AU  - Billia F
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada.
FAU - Rao, Vivek
AU  - Rao V
AD  - Peter Munk Cardiac Centre, Toronto General Hospital-University Health Network, 
      Toronto, Ontario, Canada. Electronic address: vivek.rao@uhn.ca.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20200622
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Female
MH  - Heart Failure/physiopathology/*surgery
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - *Quality of Life
MH  - *Registries
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Ventricular Function, Left/*physiology
EDAT- 2020/06/26 06:00
MHDA- 2021/06/30 06:00
CRDT- 2020/06/26 06:00
PHST- 2020/03/19 00:00 [received]
PHST- 2020/06/10 00:00 [revised]
PHST- 2020/06/12 00:00 [accepted]
PHST- 2020/06/26 06:00 [pubmed]
PHST- 2021/06/30 06:00 [medline]
PHST- 2020/06/26 06:00 [entrez]
AID - S0828-282X(20)30573-0 [pii]
AID - 10.1016/j.cjca.2020.06.010 [doi]
PST - ppublish
SO  - Can J Cardiol. 2021 Mar;37(3):467-475. doi: 10.1016/j.cjca.2020.06.010. Epub 2020 
      Jun 22.