Journal article
Dynamic Risk Estimation of Adverse Events in Ambulatory LVAD Patients
JACC. Heart failure, v 12(11), pp 1898-1912
Nov 2024
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Hemocompatibility-related adverse events affect patients after left ventricular assist device (LVAD) implantation but are hard to predict.
Dynamic risk modeling with a multistate model can predict risk of gastrointestinal bleeding (GIB), stroke, or death in ambulatory patients.
This was a secondary analysis of the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) trial. HeartMate 3 LVAD recipients who survived to hospital discharge and were followed for up to 2 years. A total of 145 variables were included in the multistate model with multivariate logistic regression. Model performance was assessed with the area under the curve in a holdout validation cohort. A risk stratification tool was created by dividing patients into categories of predicted risk using the final model variables and associated OR.
Among 2,056 LVAD patients, the median age was 59.4 years (20.4% women, 28.6% Black). At 2 years, the incidence of GIB, stroke, and death was 25.6%, 6.0%, and 12.3%, respectively. The multistate model included 39 total variables to predict risk of GIB (16 variables), stroke (10 variables), and death (19 variables). When ambulatory patients were classified according to their risk category, the 30-day observed event rate in the highest risk group for GIB, stroke, or death was 26.9%, 1.8%, and 4.8%, respectively. The multistate model predicted GIB, stroke, and death at any 30-day period with an area under the curve of 0.70, 0.69, and 0.86, respectively.
The multistate model informs 30-day risk in ambulatory LVAD recipients and allows recalculation of risk as new patient-specific data become available. The model allows for accurate risk stratification that predicts impending adverse events and may guide clinical decision making. (MOMENTUM 3 IDE Clinical Study Protocol; NCT02224755)
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Details
- Title
- Dynamic Risk Estimation of Adverse Events in Ambulatory LVAD Patients
- Creators
- Palak Shah - Inova Health SystemGabriel Sayer - NewYork–Presbyterian HospitalShashank S. Sinha - Inova Design SolutionsManreet K. Kanwar - Allegheny Health NetworkJennifer A. Cowger - Henry Ford HospitalFrancis D. Pagani - University of Michigan–Ann ArborAditi Nayak - Brigham and Women's HospitalMandeep R. Mehra - Brigham and Women's HospitalJoseph C. Cleveland - University of Colorado DenverMitchell A. Psotka - Inova Design SolutionsRamesh Singh - Inova Design SolutionsShashank S. Desai - Inova Design SolutionsQianhui Lu - AbbottYajing Hu - AbbottAllison Connolly - AbbottRobert L. Kormos - AbbottNir Uriel - New York Hospital Queens
- Publication Details
- JACC. Heart failure, v 12(11), pp 1898-1912
- Publisher
- Elsevier; London
- Number of pages
- 15
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001351203700001
- Scopus ID
- 2-s2.0-85200881372
- Other Identifier
- 991021932099604721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems