INTERMACS Profiles and Outcomes of Ambulatory Advanced Heart Failure Patients: A Report from the REVIVAL Registry

Abstract Introduction Ambulatory patients with advanced heart failure are often considered for advanced therapies, including durable mechanical circulatory support (MCS). The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profiles are a commonly used descriptor of disease severity in patients receiving MCS devices, but their role in defining the prognosis of ambulatory patients is less well-established, especially for Profiles 6 and 7. Methods REVIVAL is a prospective, observational study of 400 outpatients from 21 MCS/cardiac transplant centers. Eligible patients had NYHA class II-IV symptoms despite optimal medical and electrical therapies with a recent heart failure hospitalization, heart transplant listing, or evidence of high neurohormonal activation. Results The cohort included 33 (8%) INTERMACS Profile 4, 83 (21%) Profile 5, 155 (39%) Profile 6, and 129 (32%) Profile 7. Across INTERMACS Profiles, there were no differences in age, gender, ejection fraction, blood pressure, or use of guideline-directed medical therapy. A lower INTERMACS Profile was associated with more hospitalizations, greater frailty and more impaired functional capacity and quality of life. The composite endpoint of death, durable MCS, or urgent transplant at 12 months occurred in 39%, 27%, 24%, and 14% subjects with INTERMACS Profiles 4, 5, 6, and 7, respectively (p = 0.004). Conclusions Among ambulatory patients with advanced heart failure, a lower INTERMACS Profile was associated with a greater burden of heart failure across multiple dimensions and a higher composite risk of durable MCS, urgent transplant, or death. These Profiles may assist in risk assessment and triaging ambulatory patients to advanced therapies.