Browsing by Autor "Carmelo A. Milano"

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    Abstract 10948: Patient-reported Quality of Life is a Predictor of Outcomes After Left Ventricular Assist Device Compared to Medical Therapy - Results From the ROADMAP Study
    (Lippincott Williams & Wilkins, 2015) Josef Stehlik; Donald Haas; Jerry D. Estep; Craig H. Selzman; Joseph G. Rogers; Carmelo A. Milano; Douglas Horstmanshof; James W. Long; Brian A. Bruckner; Nader Moazami
    Introduction: The ROADMAP study examined outcomes in subjects with non-inotrope dependent advanced heart failure (n-HF) selected for either left ventricular assist device (LVAD) or optimal medical management (OMM). At 12 months, more LVAD subjects achieved the composite endpoint of survival and ≥75m improvement in 6-minute walk distance (6MWD), while all-cause mortality was similar in the 2 groups. This suggests the focus in decision-making should be on health related quality of life (HRQoL). Aim: The aim of this study was to identify predictors of favorable outcome in n-HF patients treated with LVAD or OMM. Methods: We analyzed ROADMAP study data from 200 n-HF pts receiving LVAD or OMM. HRQoL was assessed with the EQ-5D visual analog scale (VAS) that ranged from 0 (worst) to 100 (best) health status. Results: At baseline, both LVAD and OMM group had markedly impaired exertional capacity and HRQoL (Table 1). We found that baseline VAS was a powerful predictor of the utility of LVAD therapy. Subjects with VAS<60 at baseline were more likely to achieve a positive outcome at 12 months (defined as survival with ≥75m 6MWD increase or survival with HRQoL VAS≥60) with LVAD compared to OMM (Table 1) thus favoring LVAD for these patients. No significant difference between treatments was seen for those with VAS≥60 at baseline (Table 1), supporting continued OMM. Similar results were seen when the examined outcome was survival as treated on original therapy (Figure 1). Conclusions: Patients with poor baseline QoL benefit the most from LVAD therapy compared to continued OMM. HRQoL assessed by EQ5D VAS provides valuable information that can aid in identification of suitable candidates for LVAD therapy.