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Low Accuracy of the HeartMate Risk Score for Predicting Mortality Using the INTERMACS Registry Data
Journal article   Open access   Peer reviewed

Low Accuracy of the HeartMate Risk Score for Predicting Mortality Using the INTERMACS Registry Data

Manreet K. Kanwar, Lisa C. Lohmueller, Robert L. Kormos, Natasha A. Loghmanpour, Raymond L. Benza, Robert J. Mentz, Stephen H. Bailey, Srinivas Murali and James F. Antaki
ASAIO journal (1992), v 63(3), pp 251-256
01 May 2017
DOI: https://doi.org/10.1097/MAT.0000000000000494
PMID: 27984320
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc5411307View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Engineering, Biomedical Life Sciences & Biomedicine Science & Technology Transplantation Engineering Technology
Selection is a key determinant of clinical outcomes after left ventricular assist device (LVAD) placement in patients with end-stage heart failure. The HeartMate II risk score (HMRS) has been proposed to facilitate risk stratification and patient selection for continuous flow pumps. This study retrospectively assessed the performance of HMRS in predicting 90 day and 1 year mortality in patients within the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). A total of 11,523 INTERMACS patients who received a continuous flow LVAD between 2010 and 2015 were retrospectively categorized per their calculated HMRS to predict their 90 day and 1 year risk of mortality. The performance of the score was evaluated by the area under curve (AUC) of the receiver operator characteristic. We also performed multiple regression analysis using variables from the HMRS calculation on the INTERMACS data. The HMRS model showed moderate discrimination for both 90 day and 1 year mortality prediction with AUCs of 61% and 59%, respectively. The predictions had similar accuracy irrespective of whether the pump was axial or centrifugal flow. Multivariable analysis using independent variables used in the original HMRS analysis revealed different set of variables to be predictive of 90 day mortality than those used to calculate HMRS. HMRS predicts both 90 day and 1 year mortality with poor discrimination when applied to a large cohort of LVAD patients. Newer risk prediction models are therefore needed to optimize the therapeutic application of LVAD therapy. Patient selection for appropriate use of LVADs is critical. Currently available risk stratification tools (HMRS) continue to be limited in their ability to accurately predict mortality after LVAD. This study highlights these limitations when applied to a large, comprehensive, multicenter database. HMRS predicts mortality with only modest discrimination when applied to a large cohort of LVAD patients. Better risk stratification tools are needed to optimize outcomes.

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17 citations in Web of Science
21 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Engineering, Biomedical
Transplantation
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