Elderly HF Patients Reap Big Benefits, but Miss Out on LVADs
Survival, functional outcomes, and quality of life after left ventricular assist device (LVAD) are ill-defined in elderly patients, and with new-generation devices.

This study sought to evaluate survival, functional outcomes, and quality of life after LVAD in contemporary practice.

Adults receiving durable LVADs between January 1, 2010, and March 1, 2020, were identified from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The primary outcome was adjusted survival; secondary outcomes included quality of life rated using a visual analogue scale (where 0 represents “worst health” and 100 “best health”); 6-minute walk distance; stroke; device malfunction; and rehospitalization, stratified by patient age. Median follow-up was 15 months (IQR: 6-32 months).

Results:
-- The cohort comprised 68.9% (n = 16,808) patients aged less than 65 years, 26.3% (n = 6,418) patients aged 65-75 years, and 4.8% (n = 1,182) patients aged more than 75 years, who were predominantly male (n = 19,119, 78%) and on destination therapy (n = 12,425, 51%).

-- Competing outcomes analysis demonstrated mortality of 34%, 54%, and 66% for patients aged less than 65, 65-75, and more than 75 years, respectively, which improved during the study in patients aged more than 75 years.

-- Newer-generation devices were associated with reduced late mortality.

-- Stroke, device malfunction or thrombosis, and rehospitalizations decreased with increasing age.

-- Median 6-minute walk distance increased from 0 feet to 1,065 feet, and quality of life improved from 40 to 75 after LVAD in all age groups.

Conclusively, in elderly patients, LVADs are associated with increased functional capacity, similar improvements in quality of life, and fewer complications compared with younger patients.

Source: https://www.jacc.org/doi/10.1016/j.jacc.2021.06.035
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