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Predictors of Ventricular Arrhythmia Resolution after Continuous Flow-Left Ventricular Assist Device (CF-LVAD) Implantation
The 22nd Annual Scientific Meeting HFSA
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Charlson Comorbidity Index Predicts Survival after ICD Implant in Veterans Over the Age of 70 Jacqueline R. Gannuscio, Hans Moore; VA Medical Center, Washington, DC
Predictors of Ventricular Arrhythmia Resolution after Continuous Flow-Left Ventricular Assist Device (CF-LVAD) Implantation Deep Pujara, Faisal H. Cheema, Brian D. Greet, Ajith Nair, L. Simpson, A. Civitello, Francia Rojas-Delgado, Jei Cheng, Jeffrey A. Morgan, Nilesh Mathuria; Baylor College of Medicine & Texas Heart Institute, Houston, TX
Background: ICDs for prevention of sudden death are associated with improved survival in patients with chronic heart failure (HF). Outcomes of patients over 70 years age are underrepresented in registries and randomized trials. Older age and comorbidities are known markers of higher risk of death; however, little is known about ICD outcomes in the elderly. Methods: Using data in the VA Eastern Pacemaker Surveillance database, patients were evaluated for the influence of comorbidities and age on survival over a 10 year period. Medical records were reviewed for mortality predictors including age, and 17 comorbidity variables in the Charlson Comorbidity index (CCI). Kaplan Meier survival analysis was conducted and logistic regression models were used to assess risk of death. When available, the mode of death (arrhythmic, non-arrhythmic cardiac and non-cardiac death) was analyzed. Results: Of 518 patients identified, 363 had full datasets: 83% had systolic HF, mean (SD) EF was 26% (11.2), and mean (SD) age was 64 (10.4) years. During the study period 156 patients died (43%), with mean time to death of 6.06 (3.34) years. Total CCI Score was associated with increased mortality, r=.254, p<.0005, and age, r=.338, p<.0005. In Kaplan Meier analysis, patients aged 80 years had worse survival than those aged <60, 60-69, and 70-79, X2(3) = 32.14, p<.0005. In a multivariate model, age groups were a predictor of time to death (p<.0001) after controlling for race, sex, ICD indication, treatment. The mode of death was available in 116 (32%): 20% died of sudden death or cardiopulmonary arrest, 37% died of non-arrhythmic cardiac events, and 43% died of non-cardiac causes. There was no association between age and mode of death, nor a statistically significant difference in Kaplan Meier survival for the different modes of death. Conclusion: In well treated post ICD patients with systolic HF, age and CCI score were associated with shorter survival. To determine benefit to elderly patients, more research is needed on the specific comorbidities that should be assessed.
Background: A significant proportion of patients with history of ventricular arrhythmia experience resolution of ventricular arrhythmia(VAs) after implantation of continuous-flow left ventricular assist devices (CF-LVADs). Factors associated with resolution of these VAs remain unexplored. Objective: Identify factors associated with resolution of ventricular arrhythmia after CF-LVAD implantation. Methods: A single center retrospective review of patients undergoing CF-LVAD implantation between 2000 and 2015 was done to identify patients with documented history of at least one episode of VT, VF or VT storm preoperatively. Patient characteristics, operative variables and outcomes including development of arrhythmia were assessed. Results: 192 patients(82 females (42.71%); 46 patients with age >65 (23.96%)) with previously documented ventricular arrhythmia underwent CF-LVAD implant. 60 (31.3%) patients developed at least 1 episode of ventricular arrhythmia(VAs) after CF-LVAD, whereas 132 (68.7%) experienced no ventricular arrhythmia during the follow-up period. On multivariable analysis, emergent status (OR: 2.97, p=0.040) and need for temporary Mechanical Circulatory Support (2.09, p=0.033) were associated with increased odds of resolution of VAs, whereas previous cardiac surgery (OR:0.47, p=0.038) and use of multiple anti-arrhythmic drugs (OR:0.32, p=0.010) were associated with reduced likelihood of resolution of VAs after CF-LVAD implant. Conclusions: Features suggestive of acute hemodynamic failure demonstrated better odds of VA resolution after CF-LVAD implant, whereas structural damage after previous cardiac procedure and severe rhythm disorders requiring aggressive management were associated with reduced likelihood of resolution of VAs after CF-LVAD implant.
S67
174
175
Charlson Comorbidity Index Predicts Survival after ICD Implant in Veterans Over the Age of 70 Jacqueline R. Gannuscio, Hans Moore; VA Medical Center, Washington, DC
Predictors of Ventricular Arrhythmia Resolution after Continuous Flow-Left Ventricular Assist Device (CF-LVAD) Implantation Deep Pujara, Faisal H. Cheema, Brian D. Greet, Ajith Nair, L. Simpson, A. Civitello, Francia Rojas-Delgado, Jei Cheng, Jeffrey A. Morgan, Nilesh Mathuria; Baylor College of Medicine & Texas Heart Institute, Houston, TX
Background: ICDs for prevention of sudden death are associated with improved survival in patients with chronic heart failure (HF). Outcomes of patients over 70 years age are underrepresented in registries and randomized trials. Older age and comorbidities are known markers of higher risk of death; however, little is known about ICD outcomes in the elderly. Methods: Using data in the VA Eastern Pacemaker Surveillance database, patients were evaluated for the influence of comorbidities and age on survival over a 10 year period. Medical records were reviewed for mortality predictors including age, and 17 comorbidity variables in the Charlson Comorbidity index (CCI). Kaplan Meier survival analysis was conducted and logistic regression models were used to assess risk of death. When available, the mode of death (arrhythmic, non-arrhythmic cardiac and non-cardiac death) was analyzed. Results: Of 518 patients identified, 363 had full datasets: 83% had systolic HF, mean (SD) EF was 26% (11.2), and mean (SD) age was 64 (10.4) years. During the study period 156 patients died (43%), with mean time to death of 6.06 (3.34) years. Total CCI Score was associated with increased mortality, r=.254, p<.0005, and age, r=.338, p<.0005. In Kaplan Meier analysis, patients aged 80 years had worse survival than those aged <60, 60-69, and 70-79, X2(3) = 32.14, p<.0005. In a multivariate model, age groups were a predictor of time to death (p<.0001) after controlling for race, sex, ICD indication, treatment. The mode of death was available in 116 (32%): 20% died of sudden death or cardiopulmonary arrest, 37% died of non-arrhythmic cardiac events, and 43% died of non-cardiac causes. There was no association between age and mode of death, nor a statistically significant difference in Kaplan Meier survival for the different modes of death. Conclusion: In well treated post ICD patients with systolic HF, age and CCI score were associated with shorter survival. To determine benefit to elderly patients, more research is needed on the specific comorbidities that should be assessed.
Background: A significant proportion of patients with history of ventricular arrhythmia experience resolution of ventricular arrhythmia(VAs) after implantation of continuous-flow left ventricular assist devices (CF-LVADs). Factors associated with resolution of these VAs remain unexplored. Objective: Identify factors associated with resolution of ventricular arrhythmia after CF-LVAD implantation. Methods: A single center retrospective review of patients undergoing CF-LVAD implantation between 2000 and 2015 was done to identify patients with documented history of at least one episode of VT, VF or VT storm preoperatively. Patient characteristics, operative variables and outcomes including development of arrhythmia were assessed. Results: 192 patients(82 females (42.71%); 46 patients with age >65 (23.96%)) with previously documented ventricular arrhythmia underwent CF-LVAD implant. 60 (31.3%) patients developed at least 1 episode of ventricular arrhythmia(VAs) after CF-LVAD, whereas 132 (68.7%) experienced no ventricular arrhythmia during the follow-up period. On multivariable analysis, emergent status (OR: 2.97, p=0.040) and need for temporary Mechanical Circulatory Support (2.09, p=0.033) were associated with increased odds of resolution of VAs, whereas previous cardiac surgery (OR:0.47, p=0.038) and use of multiple anti-arrhythmic drugs (OR:0.32, p=0.010) were associated with reduced likelihood of resolution of VAs after CF-LVAD implant. Conclusions: Features suggestive of acute hemodynamic failure demonstrated better odds of VA resolution after CF-LVAD implant, whereas structural damage after previous cardiac procedure and severe rhythm disorders requiring aggressive management were associated with reduced likelihood of resolution of VAs after CF-LVAD implant.