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Smoking is Associated With Pump Thrombosis After Left Ventricular Assist Device Implantation
S98 Journal of Cardiac Failure Vol. 21 No. 8S August 2015 stroke, LVAD-related infection, or hemolysis/pump thrombosis. Conclusions: In this cohort of patients implanted with CF-LVADs, poor health literacy was associated with a higher incidence of adverse events, primarily GIB.
226 Smoking is Associated With Pump Thrombosis After Left Ventricular Assist Device Implantation Vaiibhav Patel, Michael Nassif, David Raymer, Brian Pierce, Justin Vader, Greg Ewald, Shane LaRue; Washington University, Saint Louis, MO
Figure 1.
225 Health Literacy as a Predictor of Adverse Outcomes after Implantation of Left Ventricular Assist Device David Raymer, Justin Vader, Anne Platts, Michael Nassif, Scott Silvestry, Gregory Ewald, Shane LaRue; Washington University / Barnes-Jewish Hospital, St. Louis, MO Introduction: Poor health literacy is associated with worse outcomes in patients with heart failure; however, the role of health literacy in predicting outcomes in patients implanted with left ventricular assist devices (LVADs) has not yet been studied. We hypothesized that health literacy would independently influence clinical outcomes in patients implanted with continuous-flow LVADs (CF-LVADs). Hypothesis: Poor health literacy is associated with worse outcomes in patients with end-stage heart failure implanted with CF-LVADs. Methods: We performed a prospective, single center, cohort study of adult patients with implanted CFLVADs. We identified 118 patients implanted with a Heart Mate II (n5101) or an HVAD (n517) implanted between 8/2005 and 9/2013. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM), with adequate health literacy defined as a score $ 61 (REALM IV) and poor literacy defined as a score ! 61 (REALM I-III). The primary outcome was combined all-cause death, stroke, gastrointestinal bleeding (GIB), LVAD-related infection, or hemolysis/pump thrombosis; components of the combined primary outcome were analyzed separately as secondary outcomes. Results: The majority of patients were implanted with Heart Mate II LVADs and had an INTERMACS profile of 2. The poor health literacy group (n538) had significantly more patients with a history of smoking (76% vs. 49%, p 5 0.005), a destination therapy strategy (53% vs. 30%, p 5 0.05), and a history of GIB (58% vs. 26%, p 5 0.003). There were no significant differences between cohorts with respect to age, date of implant, BMI, race, sex, etiology of cardiomyopathy, or history of diabetes. During a follow-up period of 88.8 patient-years there were 89 events: 32 in the poor health literacy group and 57 in the adequate health literacy group (84% vs. 71%, HR 1.56, CI 1.01-2.42, p 5 0.0466), see figure. This was driven primarily by GIB events of which there were 22 in both groups (58% vs. 28%, HR 2.57, CI 1.56-5.81). There were no significant differences in individual secondary outcomes of all-cause death,
Introduction: Pump thrombosis (PT) of continuous-flow left ventricular assist devices (CF-LVADs) is a potentially devastating complication. Understanding the factors that predispose patients to PT may lead to improved survival through better patient selection and more aggressive anticoagulation. Hypothesis: In CF-LVAD patients, active smoking at the time of implantation is associated with increased risk of PT. Methods: We retrospectively identified 442 consecutive patients who underwent continuous flow LVAD implantation between 1/2005 and 9/2014. A multivariable Cox regression analysis of the association between PT and risk factors present during the implant hospitalization was performed. The final model included the variables age, sex, use of erythropoietin stimulating agents (ESAs), BMI, and history of smoking. A chart review was conducted to determine whether there was an increased risk of PT in current smokers compared to prior smokers. Patients were divided into never smokers (n5189), former smokers documented as having quit at least 90 days prior to LVAD implantation (n5218), and current smokers (n541). Suspected PT was defined as sustained severe hemolysis as evidenced by LDH O 1,000 mg/dL. The primary end point was time to PT, and secondary end points included time to gastrointestinal bleed (GIB) and time to death. Results: Median follow up was 10.3 months after implantation. The majority of patients were white (77%), male (81%), and had a median INTERMACS profile of 2. After adjusting for age, sex, BMI and ESA usage, a history of smoking remained associated with suspected PT, HR 1.823 (95% CI 1.095 - 3.036; p 5 0.021). Current smokers had the highest rate of suspected PT at 27% vs. 17% for former smokers, and 12% for never smokers (p 5 0.039) (see Figure 1). There was no difference in mortality between the three groups and no difference in time to GIB. Conclusion: Patients who were active smokers at the time of CF-LVAD implantation had significantly higher rates of pump thrombosis. There was no association between smoking and rates of gastrointestinal bleeding or mortality. In stable patients with plans for elective LVAD implantation, smoking cessation should be strongly encouraged.
Figure 1.
227 Long Term Support of Acute, Refractory Cardiogenic Shock with an Extracorporeal, Continuous Flow Ventricular Assist Device: A Seven Year Experience James M. Meza1, Yamini Krishnamurthy2, Laura Blue1, Jacob Schroder1, Chetan B. Patel1, Carmelo A. Milano1, Mani A. Daneshmand1; 1Duke University Medical Center, Durham, NC; 2Duke University School of Medicine, Durham, NC
Figure 1.
Introduction: Temporary mechanical circulatory support can be initiated for acute refractory cardiogenic shock, though morbidity and mortality remain high. We report our seven-year experience with an extracorporeal, continuous flow ventricular assist device (ecfVAD). Hypothesis: The ecfVAD is safe and effective as long term support for cardiogenic shock. Methods: A retrospective review of patients at our institution supported with an ecfVAD from 2007-2014 was performed. ecfVADs were implanted for cardiogenic shock as a bridge to decision or when a high likelihood of ventricular recovery existed. Pre- and post-implantation data were collected. Summary statistics were calculated and survival analysis was performed. Results: There were 94 patients supported with ecfVADs for 1,680 total days. The median age at implantation was 55 years (IQR 45-63). In this cohort, 33.0% (31/94)
226 Smoking is Associated With Pump Thrombosis After Left Ventricular Assist Device Implantation Vaiibhav Patel, Michael Nassif, David Raymer, Brian Pierce, Justin Vader, Greg Ewald, Shane LaRue; Washington University, Saint Louis, MO
Figure 1.
225 Health Literacy as a Predictor of Adverse Outcomes after Implantation of Left Ventricular Assist Device David Raymer, Justin Vader, Anne Platts, Michael Nassif, Scott Silvestry, Gregory Ewald, Shane LaRue; Washington University / Barnes-Jewish Hospital, St. Louis, MO Introduction: Poor health literacy is associated with worse outcomes in patients with heart failure; however, the role of health literacy in predicting outcomes in patients implanted with left ventricular assist devices (LVADs) has not yet been studied. We hypothesized that health literacy would independently influence clinical outcomes in patients implanted with continuous-flow LVADs (CF-LVADs). Hypothesis: Poor health literacy is associated with worse outcomes in patients with end-stage heart failure implanted with CF-LVADs. Methods: We performed a prospective, single center, cohort study of adult patients with implanted CFLVADs. We identified 118 patients implanted with a Heart Mate II (n5101) or an HVAD (n517) implanted between 8/2005 and 9/2013. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM), with adequate health literacy defined as a score $ 61 (REALM IV) and poor literacy defined as a score ! 61 (REALM I-III). The primary outcome was combined all-cause death, stroke, gastrointestinal bleeding (GIB), LVAD-related infection, or hemolysis/pump thrombosis; components of the combined primary outcome were analyzed separately as secondary outcomes. Results: The majority of patients were implanted with Heart Mate II LVADs and had an INTERMACS profile of 2. The poor health literacy group (n538) had significantly more patients with a history of smoking (76% vs. 49%, p 5 0.005), a destination therapy strategy (53% vs. 30%, p 5 0.05), and a history of GIB (58% vs. 26%, p 5 0.003). There were no significant differences between cohorts with respect to age, date of implant, BMI, race, sex, etiology of cardiomyopathy, or history of diabetes. During a follow-up period of 88.8 patient-years there were 89 events: 32 in the poor health literacy group and 57 in the adequate health literacy group (84% vs. 71%, HR 1.56, CI 1.01-2.42, p 5 0.0466), see figure. This was driven primarily by GIB events of which there were 22 in both groups (58% vs. 28%, HR 2.57, CI 1.56-5.81). There were no significant differences in individual secondary outcomes of all-cause death,
Introduction: Pump thrombosis (PT) of continuous-flow left ventricular assist devices (CF-LVADs) is a potentially devastating complication. Understanding the factors that predispose patients to PT may lead to improved survival through better patient selection and more aggressive anticoagulation. Hypothesis: In CF-LVAD patients, active smoking at the time of implantation is associated with increased risk of PT. Methods: We retrospectively identified 442 consecutive patients who underwent continuous flow LVAD implantation between 1/2005 and 9/2014. A multivariable Cox regression analysis of the association between PT and risk factors present during the implant hospitalization was performed. The final model included the variables age, sex, use of erythropoietin stimulating agents (ESAs), BMI, and history of smoking. A chart review was conducted to determine whether there was an increased risk of PT in current smokers compared to prior smokers. Patients were divided into never smokers (n5189), former smokers documented as having quit at least 90 days prior to LVAD implantation (n5218), and current smokers (n541). Suspected PT was defined as sustained severe hemolysis as evidenced by LDH O 1,000 mg/dL. The primary end point was time to PT, and secondary end points included time to gastrointestinal bleed (GIB) and time to death. Results: Median follow up was 10.3 months after implantation. The majority of patients were white (77%), male (81%), and had a median INTERMACS profile of 2. After adjusting for age, sex, BMI and ESA usage, a history of smoking remained associated with suspected PT, HR 1.823 (95% CI 1.095 - 3.036; p 5 0.021). Current smokers had the highest rate of suspected PT at 27% vs. 17% for former smokers, and 12% for never smokers (p 5 0.039) (see Figure 1). There was no difference in mortality between the three groups and no difference in time to GIB. Conclusion: Patients who were active smokers at the time of CF-LVAD implantation had significantly higher rates of pump thrombosis. There was no association between smoking and rates of gastrointestinal bleeding or mortality. In stable patients with plans for elective LVAD implantation, smoking cessation should be strongly encouraged.
Figure 1.
227 Long Term Support of Acute, Refractory Cardiogenic Shock with an Extracorporeal, Continuous Flow Ventricular Assist Device: A Seven Year Experience James M. Meza1, Yamini Krishnamurthy2, Laura Blue1, Jacob Schroder1, Chetan B. Patel1, Carmelo A. Milano1, Mani A. Daneshmand1; 1Duke University Medical Center, Durham, NC; 2Duke University School of Medicine, Durham, NC
Figure 1.
Introduction: Temporary mechanical circulatory support can be initiated for acute refractory cardiogenic shock, though morbidity and mortality remain high. We report our seven-year experience with an extracorporeal, continuous flow ventricular assist device (ecfVAD). Hypothesis: The ecfVAD is safe and effective as long term support for cardiogenic shock. Methods: A retrospective review of patients at our institution supported with an ecfVAD from 2007-2014 was performed. ecfVADs were implanted for cardiogenic shock as a bridge to decision or when a high likelihood of ventricular recovery existed. Pre- and post-implantation data were collected. Summary statistics were calculated and survival analysis was performed. Results: There were 94 patients supported with ecfVADs for 1,680 total days. The median age at implantation was 55 years (IQR 45-63). In this cohort, 33.0% (31/94)