Influence of postimplant mitral regurgitation on durable left ventricular assist device outcomes.

Background: The association of significant postimplant mitral regurgitation (PI-MR) with left ventricular assist device (LVAD) outcomes remains controversial. We investigated PI-MR in the setting of contemporary LVAD therapy.

Methods: The Society of Thoracic Surgeons Intermacs National Database was queried and identified 2858 patients with a fully magnetically levitated centrifugal flow LVAD implanted from 2017 to 2021 who met study inclusion and exclusion criteria.

Association Between Left Ventricular Assist Device Infections and Number of Shared Patients Among Care Providers: A Network Analysis.

Background: For patients on durable left ventricular assist devices, prior work has documented that more shared patients among clinicians (connectedness) is associated with improved long-term outcomes. This study examines the association between preadmission clinician connectedness, patient acuity, and postimplant outcomes including infections.

Methods: The Society of Thoracic Surgeons Intermacs National Database was linked to Medicare claims to identify patients undergoing durable left ventricular assist device implantation between 2009 and 2017.

Clinician attitudes, opinions and practice patterns regarding inotrope use for cardiac surgery in the USA: a multicentre mixed methods study protocol.

Introduction: Cardiac inotrope medications administered to cardiac surgical patients carry steep risk-benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for cardiac surgery, limited multicentre data exist regarding determinants of inotrope selection and time course for use. Additionally, the reasons that underpin how clinicians decide on inotrope usage and the factors that influence inotrope practice change are not well understood.

Psychosocial Risk Assessment for Heart Transplantation: Evaluating for Bias and Impact on Post-transplant Outcomes.

Background: Pretransplant psychosocial risk (PSR) assessment is subjective, so we investigated potential biases and the relationship between assessed PSR and post-transplant outcomes at our heart transplant center.

Methods: Between 05/2004 and 01/2021, 479 heart transplant (HT) recipients had a pre-transplant psychosocial evaluation, at which a social worker collected information about 25 characteristics and categorized the candidate's PSR for post-transplant death. Relationships between PSR and post-transplant outcomes (death, hospitalization and rejection) were evaluated.

Enhancing Qualitative and Quantitative Data Linkages in Complex Mixed Methods Designs: Illustrations from a Multi-Phase Healthcare Delivery Study.

While mixed methods research is increasingly used to examine determinants of unwarranted variability in healthcare delivery and outcomes, novel integrative approaches are required to meet the needs of mixed methods healthcare delivery research. This article describes novel refining strategies that enhance the linkage between qualitative and quantitative dimensions of a mixed methods healthcare delivery research study. Leveraging our study experiences, this paper demonstrates several refining strategies: (1) using mediated allocation concealment to facilitate qualitative sampling; (2) informing qualitative inquiry through quantitative analytics; and (3) training and immersing multidisciplinary researchers in qualitative data collection and analysis.

Optimizing Triage of Ambulatory Patients With Advanced Heart Failure: 2-Year Outcomes From REVIVAL.

Background: Left ventricular assist device (LVAD) use remains uncommon in advanced heart failure (HF) patients not dependent on inotropes.

Objectives: Before considering a randomized trial comparing a strategy of earlier use of LVAD to continued medical therapy, a better understanding is needed of the clinical trajectory of ambulatory patients with advanced systolic HF on optimal guideline-directed medical therapy (GDMT).

Methods: REVIVAL enrolled 400 patients with advanced ambulatory systolic HF, ≥1 HF mortality risk marker (≥2 HF hospitalizations past year; or HF hospitalization and high natriuretic peptide; or no HF hospitalizations but low peak oxygen consumption, 6-minute walk, serum sodium, HF survival score or Seattle HF model predicted survival), and no LVAD contraindication at 21 LVAD centers from July 2015 to June 2016.

Enhancing heart failure treatment decisions: interpretable machine learning models for advanced therapy eligibility prediction using EHR data.

Timely and accurate referral of end-stage heart failure patients for advanced therapies, including heart transplants and mechanical circulatory support, plays an important role in improving patient outcomes and saving costs. However, the decision-making process is complex, nuanced, and time-consuming, requiring cardiologists with specialized expertise and training in heart failure and transplantation. In this study, we propose two logistic tensor regression-based models to predict patients with heart failure warranting evaluation for advanced heart failure therapies using irregularly spaced sequential electronic health records at the population and individual levels.

Determinants of survival following heart transplantation in adults with congenital heart disease.

Background: Adult patients surviving with congenital heart disease (ACHD) is growing. We examine the factors associated with heart transplant outcomes in this challenging population with complex anatomy requiring redo-surgeries.

Methods: We reviewed the United Network for Organ Sharing-Standard Transplant Analysis and Research database and analyzed 35,952 heart transplants from January 1st, 2000, to September 30th, 2018.

Cardiac Rehabilitation Use After Heart Failure Hospitalization Associated With Advanced Heart Failure Center Status.

Purpose: Cardiac rehabilitation (CR) is an evidence-based, guideline-endorsed therapy for patients with heart failure with reduced ejection fraction (HFrEF) but is broadly underutilized. Identifying structural factors contributing to increased CR use may inform quality improvement efforts. The objective here was to associate hospitalization at a center providing advanced heart failure (HF) therapies and subsequent CR participation among patients with HFrEF.

Gastrointestinal bleeding following Heartmate 3 left ventricular assist device implantation: The Michigan Bleeding Risk Model.

Background: Gastrointestinal bleeding (GIB) results in frequent hospitalizations and impairs quality of life in durable left ventricular assist device (LVAD) recipients. Anticipation of these events before implantation could have important implications for patient selection and management.

Methods: The study population included all adult HeartMate 3 (HM3) primary LVAD recipients enrolled in the STS Intermacs registry from January 2017 to December 2020.

A Practical Approach to Disease Risk Prediction: Focus on High-Risk Patients via Highest- Loss.

Disease risk prediction models play an important role in preventing disease developments in modern healthcare. However, the lack of focus on high-risk patients has hindered the large-scale practical application of these models, especially considering the limitation of medical resources available for following up on patients who are deemed high-risk. In this study, we propose a novel and practical approach that focuses on minimizing the number of false positive observations among high-risk patients by introducing the -.

Predicting need for heart failure advanced therapies using an interpretable tropical geometry-based fuzzy neural network.

Background: Timely referral for advanced therapies (i.e., heart transplantation, left ventricular assist device) is critical for ensuring optimal outcomes for heart failure patients.

Longitudinal Change and Predictors of Myocardial Flow Reserve by Positron Emission Tomography for the Evaluation of Cardiac Allograft Vasculopathy Following Heart Transplantation.

Background: Positron emission tomography (PET) myocardial flow reserve (MFR) is a noninvasive method of detecting cardiac allograft vasculopathy in recipients of heart transplants (HTs). There are limited data on longitudinal change and predictors of MFR following HT.

Methods: We conducted a retrospective analysis of HT recipients undergoing PET myocardial perfusion imaging at an academic center.

Cytomegalovirus infection is associated with impaired myocardial flow reserve after heart transplantation.

Background: Cardiac allograft vasculopathy (CAV) limits long-term survival after heart transplantation (HT). This study evaluates the relationship between clinically significant cytomegalovirus infection (CS-CMVi) and CAV using cardiac positron emission tomography (PET).

Methods: We retrospectively evaluated HT patients from 2005 to 2019 who underwent cardiac PET for CAV evaluation.

Heart Failure With Recovered Ejection Fraction in Patients With Nonischemic Cardiomyopathy: Characteristics, Outcomes, and Long-term Follow-up.

Background: Duration of recovery and long-term outcomes have not been well-described in a large cohort of patients with heart failure with recovered ejection fraction (HFrecEF) owing to nonischemic cardiomyopathy. The aim of the study was to characterize the duration of recovery and long-term outcomes of patients with HFrecEF.

Methods And Results: We performed a retrospective analysis of our institution's databases.

Gastrointestinal bleeding on continuous-flow left ventricular assist device therapy.

While technological advances in the field of continuous-flow left ventricular assist device (CF-LVAD) are constantly being made, CF-LVAD recipients are still subjected to a relatively high rate of LVAD-related adverse events, with post-LVAD gastrointestinal bleeding (GIB) being the most common one. GIB is associated with a significant impairment in quality of life, multiple hospital admissions, blood transfusion requirements and possibly death. Furthermore, of those patients who bled once, many will experience recurrent GIB events, which further aggravates their discomfort.

Infections following left ventricular assist device implantation and 1-year health-related quality of life.

Background: Left ventricular assist device (LVAD) implantation leads to substantial and sustained improvement in health-related quality of life (HRQOL) among patients. Infection following device implantation remains an important and frequent complication and adversely affects patient-reported HRQOL.

Methods: Patients in The Society of Thoracic Surgeons' Interagency Registry for Mechanically Assisted Circulatory Support receiving a primary LVAD between April 2012 to October 2016 were included.

Translation of immunomodulatory therapy to treat chronic heart failure: Preclinical studies to first in human.

Background: Inflammation has been associated with progression and complications of chronic heart failure (HF) but no effective therapy has yet been identified to treat this dysregulated immunologic state. The selective cytopheretic device (SCD) provides extracorporeal autologous cell processing to lessen the burden of inflammatory activity of circulating leukocytes of the innate immunologic system.

Aim: The objective of this study was to evaluate the effects of the SCD as an extracorporeal immunomodulatory device on the immune dysregulated state of HF.

Association of Days Alive and Out of the Hospital After Ventricular Assist Device Implantation With Adverse Events and Quality of Life.

Importance: There is a need to better assess the cumulative effect on morbidity and mortality in patients undergoing durable left ventricular assist device (LVAD) implantation. This study evaluates a patient-centered performance metric (days alive and out of hospital [DAOH]) for durable LVAD therapy.

Objective: To determine the incidence of percent of DAOH before and after LVAD implantation and (2) explore its association with established quality metrics (death, adverse events [AEs], quality of life).

Preoperative clinical diagnostic accuracy of heart failure among patients undergoing major noncardiac surgery: a single-centre prospective observational analysis.

Background: Reliable diagnosis of heart failure during preoperative evaluation is important for perioperative management and long-term care. We aimed to quantify preoperative heart failure diagnostic accuracy and explore characteristics of patients with heart failure misdiagnoses.

Methods: We performed an observational cohort study of adults undergoing major noncardiac surgery at an academic hospital between 2015 and 2019.