Introduction

Patients with ambulatory advanced heart failure (HF) are increasingly considered for durable mechanical circulatory support (MCS) and heart transplantation and their effective triage requires careful assessment of the clinical trajectory.

Methods

REVIVAL, a prospective, observational study, enrolled 400 ambulatory advanced HF patients from 21 MCS/transplant centers in 2015-2016. Study design included a clinical re-assessment of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile within 120 days after enrollment. The prognostic impact of a worsening INTERMACS Profile assigned by the treating physician was assessed at 1 year after the Early Relook.

Results

Early Relook was done in 325 of 400 patients (81%), of whom 24% had a worsened INTERMACS Profile, associated with longer HF history and worse baseline INTERMACS profile, but no difference in baseline LVEF (median 0.20), 6-minute walk, quality of life, or other baseline parameters. Early worsening predicted higher rate of the combined primary endpoint of death, urgent MCS, or urgent transplant by 1 year after Early Relook, (28% vs 15%), with hazard ratio 2.2 (95% CI 1.2- 3.8; p = .006) even after adjusting for baseline INTERMACS Profile and Seattle HF Model score. Deterioration to urgent MCS occurred in 14% vs 5% (p = .006) during the year after Early Relook.

Conclusions

Early Relook identifies worsening of INTERMACS Profile in a significant population of ambulatory advanced HF, who had worse outcomes over the subsequent year. Early reassessment of ambulatory advanced HF patients should be performed to better define the trajectory of illness and inform triage to advanced therapies.

中文翻译：

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早期重新观察可确定门诊晚期心力衰竭的高风险轨迹

介绍

越来越多的门诊晚期心力衰竭 (HF) 患者被考虑接受持久的机械循环支持 (MCS) 和心脏移植，他们的有效分流需要仔细评估临床轨迹。

方法

REVIVAL 是一项前瞻性观察性研究，在 2015-2016 年间招募了来自 21 个 MCS/移植中心的 400 名门诊晚期 HF 患者。研究设计包括在入组后 120 天内对机构间机械辅助循环支持注册 (INTERMACS) 概况进行临床重新评估。在 Early Relook 后 1 年评估由主治医师指定的恶化 INTERMACS Profile 的预后影响。

结果

400 名患者中有 325 名 (81%) 进行了早期重新检查，其中 24% 的 INTERMACS 特征恶化，与较长的 HF 病史和较差的基线 INTERMACS 特征相关，但基线 LVEF（中位数 0.20）、6 分钟步行无差异、生活质量或其他基线参数。早期恶化预测 Early Relook 后 1 年死亡、紧急 MCS 或紧急移植的综合主要终点发生率更高（28% 对 15%），风险比为 2.2（95% CI 1.2-3.8；p  = .006 ) 即使在针对基线 INTERMACS 配置文件和 Seattle HF 模型分数进行调整之后。在 Early Relook 后的一年中，紧急 MCS 恶化的发生率分别为 14% 和 5% ( p  = .006)。

结论

Early Relook 发现大量动态晚期 HF 患者的 INTERMACS Profile 恶化，这些患者在随后一年的结果更差。应该对门诊晚期 HF 患者进行早期重新评估，以更好地确定疾病的发展轨迹，并告知对晚期治疗的分类。