Original Clinical SciencePresence and impact of anemia in patients supported with left ventricular assist devices
Graphical abstract
Section snippets
Data source and ethical considerations
Analysis was conducted using the INTERMACS database, a prospective registry of all Food and Drug Administration-approved durable mechanical circulatory support devices in the United States.9 Data for the current study were requested via the Biologic Specimen and Data Repository Information Coordinating Center of the National Heart, Lung, and Blood Institute (https://biolincc.nhlbi.nih.gov/home/). This study was approved by the First Affiliated Hospital of Chongqing Medical University Ethics
Study population and baseline characteristics
A total of 22,008 patients who underwent a VAD implant were included in the INTERMACS registry between 2008 and 2017. Of them, 19,597 received a primary continuous-flow LVAD implant and were included in the current study (Figure 1). The primary analysis comprises 19,509 patients with available preimplant hemoglobin values: 4,758 (24.4%) patients did not show any preimplant anemia, 5,935 (30.4%) had mild anemia, and 8,816 (45.2%) had moderate-severe anemia. Baseline characteristics of patients
Discussion
This study analyzed data from the INTERMACS database to investigate anemia presence and its impact on advanced HF patients receiving LVAD implantations. The present study has 3 main findings (Central Illustration). First, more than 75% of LVAD candidates have preimplant anemia. Although hemoglobin values increased over time, anemia remains a significant problem after LVAD implantation, with 31.2%-34.0% and 32.3%-33.5% of LVAD patients characterized by mild or moderate-severe anemia,
Strengths and limitations
The structured and systematic data collection performed by the INTERMACS database, the regular audits on data quality, and the large participation of cardiac surgery centers guarantee data robustness and granularity. Nevertheless, our study is observational by nature limiting causal inferences, and this includes the trajectories over time. In fact, modeling the trajectories in hemoglobin over time using linear mixed-effect models has the advantage to estimate differences in hemoglobin between
Conclusions
Anemia can affect more than 75% of candidates for LVAD surgery and 60.4%-67.6% of LVAD recipients from 6 months to 4 years after implantation. Any degree of anemia is correlated with higher mortality risk, worse quality of life, and poor functional status after LVAD implantation, and it might drive higher rates of bleeding events, infections, renal dysfunction, and rehospitalizations. Consequently, preimplant anemia is a significant determinant of mortality in LVAD patients. Further studies
Perspectives
Competency in medical knowledge: Anemia is a frequent comorbidity in patients before and after LVAD implant. It is associated with worse quality of life, poor functional status, higher mortality risk, and higher adverse events after LVAD implantation.
Translational Outlook: Further studies should focus on identifying the best therapeutic approach for anemia to improve the quality of life and survival of LVAD patients.
Disclosures
RL is a consultant for Medtronic, Getinge, Abiomed, and LivaNova; Advisory Board Member of Eurosets, Hemocue, and Xenios (honoraria are paid as research funding). The remaining authors have nothing to disclose.
Funding
This work was supported by the National Natural Science Foundation of China (No. 81700602), the First-class Discipline Construction Project of First Clinical College, Chongqing Medical University (No. CYYY-BSHPYXM-2022-08), the Natural Science Foundation of Chongqing, China (No. CSTB2022NSCQ-MSX0840), the CQMU Program for Youth Innovation in Future Medicine (W0153), the First Affiliated Hospital of CQMU Young Outstanding Scientific and Technological Talents Program (ZYRC2022-04), and the Senior
Acknowledgments
This article was performed using the data from INTERMACS obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center.
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