INTERMACS Profiling Identifies Risk of Death or VAD among Medically-Managed Advanced Heart Failure Patients

Purpose INTERMACS profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The role for INTERMACS profiling of advanced HF patients undergoing an initial strategy of medical management is not yet known. Methods and Materials The MedaMACS Screening Pilot enrolled 167 pts with chronic NYHA Class III-IV HF, EF≤30%, and ≥1 HF hospitalization in the prior year. Pts were excluded if listed for transplant or on inotropes. Comprehensive data were collected from usual care, with INTERMACS profiles assigned at enrollment using standard definitions. Subjects were followed for 12mos, or until death, VAD or transplant. Event rates were calculated by the Kaplan-Meier method and risk of death or VAD was analyzed using Cox modeling. Results Mean age was 57yrs, EF 17%, 47% had an ischemic etiology, and 57% had HF >5yrs. At enrollment 23% of subjects were INTERMACS profile 4, 32% profile 5, and 45% profile 6/7. Cumulative follow-up was 117 patient-yrs. Patients in lower INTERMACS profiles had been hospitalized more often in the prior 6 mos, were less often on a beta-blocker, and had higher Seattle HF model scores. Lower INTERMACS profile was associated with increased risk of death or VAD by 12 months. [ figure 1 ] Successively lower INTERMACS profile remained strongly associated with failure of medical therapy (HR 1.61, 95%CI 1.12-2.39) after adjustment for renal function, right ventricular function, and Seattle HF score quartile. Conclusions INTERMACS profiles are a useful short-hand for risk stratification in advanced HF. Lower profiles identify patients who may benefit from current mechanical support devices under existing indications.