Advanced age (older than 70 years) should not be used as an independent contraindication when selecting a heart failure (HF) patient for left ventricular assist device (LVAD) therapy at experienced community hospital centers, based on results of a single-center study in the June 21 issue of the Journal of the American College of Cardiology.
The FDA’s approval of the HeartMate II (Thoratec) LVAD for destination therapy has provided an “attractive option” for older patients with advanced heart failure, according to the study authors.
“With an increasing population of elderly patients with advanced heart failure who have limited treatment options, there are unanswered questions pertaining to whether older patients can benefit from and are appropriate for this technology,” wrote lead author Robert M. Adamson, MD, medical director of the cardiac transplantation program at Sharp Memorial Hospital in San Diego, and colleagues.
Fifty-five patients received the HeartMate II LVAD between Oct. 5, 2005, and Jan. 1, 2010, as part of either the bridge to transplantation or destination therapy trials at a community hospital with 368 licensed beds. Patients were divided into two age groups: 70 years of age or younger (30 patients) and older than 70 years of age (25 patients).The researchers compared outcome measures including survival, length of hospital stay, adverse events and quality of life between the two groups.
Pre-operatively, all patients were in NYHA functional Class IV refractory to maximal medical therapy. The Kaplan-Meier survival for patients 70 years of age or older (97 percent at one month, 75 percent at one year and 70 percent at two years) was not statistically different from patients younger than 70 years of age (96 percent at one month, 72 percent at one year and 65 percent at two years).
The average length of hospital stay for the group ages 70 or older was 24 days, similar to that of the group younger than 70 years of age (23 days). There were no differences in the incidence of adverse events between the two groups.
Quality of life and functional status improved significantly in both groups. “One important positive factor in the use of LVAD therapy for older patients is that they are very appreciative of the improved quality of life afforded by the LVAD. Whereas younger patients want to live longer, older patients want to live better,” the authors wrote.
Based on their results, the researchers noted that the LVAD patients 70 years of age or older have good functional recovery, survival and quality of life at two years.
Adamson and colleagues concluded that “this type of mechanical support should be considered as an attractive option for select patients refractory to maximal medical therapy, and that age should not be an absolute contraindication to LVAD support. The results also indicate that very good results can be achieved in a community hospital setting with a focused effort from a dedicated team.”
Commenting on the clinical setting, the researchers reported that their “survival rates are higher and the rates of adverse events were lower in both groups when compared with the results of the multicenter HMII [HeartMate II] trials. Similar outcomes can be achieved in other hospital settings as well.”