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Comparative Study
. 2016 Jan;46(1):34-41.
doi: 10.1111/eci.12562. Epub 2015 Dec 23.

Outcome of conservative management vs. assist device implantation in patients with advanced refractory heart failure

Christopher Adlbrecht  1   2 , Martin Hülsmann  1 , Raphael Wurm  1 , Farsad Eskandary  3 , Stephanie Neuhold  4   5 , Andreas Zuckermann  6 , Andja Bojic  1 , Guido Strunk  7 , Richard Pacher  1
Affiliations
Comparative Study

Outcome of conservative management vs. assist device implantation in patients with advanced refractory heart failure

Christopher Adlbrecht et al. Eur J Clin Invest. 2016 Jan.

Abstract

Background: In patients with advanced refractory heart failure (HF) cardiac transplantation (HTX), conservative medical management and the implantation of a ventricular assist device (VAD) represent valuable options. The determination of the best therapeutic destination strategy for the individual patient remains a challenge. The aim of this study was to assess the clinical outcome in advanced refractory HF patients either managed conservatively receiving optimal contemporary medical therapy ('conservative'), or who who underwent pulsatile flow VAD ('pVAD') or continuous-flow VAD ('contVAD') implantation.

Materials and methods: A total of 118 patients with INTERMACS profile >1 at baseline, who died, or fully completed a 24-month follow-up free from HTX were included into this retrospective analysis. All-cause mortality at 24 months was assessed and compared between the three groups.

Results: Fifty (42%) patients were managed conservatively, 25 (21%) received a pVAD and 43 (36%) a contVAD. NT-proBNP values were comparable between the three groups (median 4402 (IQR 2730-13390) pg/mL, 3580 (1602-6312) pg/mL and 3693 (2679-8065) pg/mL, P = 0·256). Mean survival was 18·6 (95% CI 16·2-21·0) months for patients managed conservatively, 7·0 (3·9-10·0) for pVAD and 20·5 (18·2-22·8) for contVAD (overall log-rank test P < 0·001). Conservatively managed patients spent a mean of 22·4 (95% CI 22·1-22·8), pVAD 17·7 (15·4-20·1) and contVAD 21·6 (21·2-22·1) months out of hospital (conservative vs. pVAD P < 0·001; conservative vs. contVAD P = 0·015; pVAD vs. contVAD P < 0·001).

Conclusions: In accordance with the literature, contVAD resulted in a significantly better clinical outcome than pVAD implantation. However, conservative management with current optimal medical therapy appears to remain a valuable option for patients with advanced HF.

Keywords: Conservative management; heart failure; ventricular assist device.

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