TY - JOUR
T1 - Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients results from the ROADMAP Study
AU - ROADMAP Study Investigators
AU - Estep, Jerry D.
AU - Starling, Randall C.
AU - Horstmanshof, Douglas A.
AU - Milano, Carmelo A.
AU - Selzman, Craig H.
AU - Shah, Keyur B.
AU - Loebe, Matthias
AU - Moazami, Nader
AU - Long, James W.
AU - Stehlik, Josef
AU - Kasirajan, Vigneshwar
AU - Haas, Donald C.
AU - O'Connell, John B.
AU - Boyle, Andrew J.
AU - Farrar, David J.
AU - Rogers, Joseph G.
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2015/10/20
Y1 - 2015/10/20
N2 - Background Data for left ventricular assist devices (LVADs) in patients with noninotrope-dependent heart failure (HF) are limited. Objectives The goal of this study was to evaluate HeartMate II (HMII) LVAD support versus optimal medical management (OMM) in ambulatory New York Heart Association functional class IIIB/IV patients meeting indications for LVAD destination therapy but not dependent on intravenous inotropic support. Methods This was a prospective, multicenter (N = 41), observational study of 200 patients (97 LVAD, 103 OMM). Entry criteria included ≥ 1 hospitalization for HF in the last 12 months and 6-min walk distance (6MWD) <300 m. The primary composite endpoint was survival on original therapy with improvement in 6MWD ≥ 75 m at 12 months. Results LVAD patients were more severely ill, with more patients classified as Interagency Registry for Mechanically Assisted Circulatory Support profile 4 (65% LVAD vs. 34% OMM; p < 0.001) than 5 to 7. More LVAD patients met the primary endpoint (39% LVAD vs. 21% OMM; odds ratio: 2.4 [95% confidence interval: 1.2 to 4.8]; p = 0.012). On the basis of as-treated analysis, 12-month survival was greater for LVAD versus OMM (80 ± 4% vs. 63 ± 5%; p = 0.022) patients. Adverse events were higher in LVAD patients, at 1.89 events/patient-year (EPPY), primarily driven by bleeding (1.22 EPPY), than with OMM, at 0.83 EPPY, primarily driven by worsening HF (0.68 EPPY). Most patients (80% LVAD vs. 62% OMM; p < 0.001) required hospitalizations. Health-related quality of life (HRQol) and depression improved from baseline more significantly with LVADs than with OMM (Δ visual analog scale: 29 ± 25 vs. 10 ± 22 [p < 0.001]; Δ Patient Health Questionnaire-9: -5 ± 7 vs. -1 ± 5 [p < 0.001]). Conclusions Survival with improved functional status was better with HMII LVAD compared with OMM. Despite experiencing more frequent adverse events, LVAD patients improved more in HRQol and depression. The results support HMII use in functionally limited, noninotrope-dependent HF patients with poor HRQoL. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device [LVAD] and Medical Management [ROADMAP]; NCT01452802)
AB - Background Data for left ventricular assist devices (LVADs) in patients with noninotrope-dependent heart failure (HF) are limited. Objectives The goal of this study was to evaluate HeartMate II (HMII) LVAD support versus optimal medical management (OMM) in ambulatory New York Heart Association functional class IIIB/IV patients meeting indications for LVAD destination therapy but not dependent on intravenous inotropic support. Methods This was a prospective, multicenter (N = 41), observational study of 200 patients (97 LVAD, 103 OMM). Entry criteria included ≥ 1 hospitalization for HF in the last 12 months and 6-min walk distance (6MWD) <300 m. The primary composite endpoint was survival on original therapy with improvement in 6MWD ≥ 75 m at 12 months. Results LVAD patients were more severely ill, with more patients classified as Interagency Registry for Mechanically Assisted Circulatory Support profile 4 (65% LVAD vs. 34% OMM; p < 0.001) than 5 to 7. More LVAD patients met the primary endpoint (39% LVAD vs. 21% OMM; odds ratio: 2.4 [95% confidence interval: 1.2 to 4.8]; p = 0.012). On the basis of as-treated analysis, 12-month survival was greater for LVAD versus OMM (80 ± 4% vs. 63 ± 5%; p = 0.022) patients. Adverse events were higher in LVAD patients, at 1.89 events/patient-year (EPPY), primarily driven by bleeding (1.22 EPPY), than with OMM, at 0.83 EPPY, primarily driven by worsening HF (0.68 EPPY). Most patients (80% LVAD vs. 62% OMM; p < 0.001) required hospitalizations. Health-related quality of life (HRQol) and depression improved from baseline more significantly with LVADs than with OMM (Δ visual analog scale: 29 ± 25 vs. 10 ± 22 [p < 0.001]; Δ Patient Health Questionnaire-9: -5 ± 7 vs. -1 ± 5 [p < 0.001]). Conclusions Survival with improved functional status was better with HMII LVAD compared with OMM. Despite experiencing more frequent adverse events, LVAD patients improved more in HRQol and depression. The results support HMII use in functionally limited, noninotrope-dependent HF patients with poor HRQoL. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device [LVAD] and Medical Management [ROADMAP]; NCT01452802)
KW - HeartMate II
KW - ROADMAP
KW - functional status
KW - quality of life
KW - risk/benefit analysis
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U2 - 10.1016/j.jacc.2015.07.075
DO - 10.1016/j.jacc.2015.07.075
M3 - Article
C2 - 26483097
AN - SCOPUS:84944067756
SN - 0735-1097
VL - 66
SP - 1747
EP - 1761
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -