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Enhancing Heart Failure Patient Care: MedaMACS Progress Report 2014

This report by Garrick C. Stewart, MD, provides insights on ambulatory heart failure patients, their comorbid conditions, outcomes, and treatment trials. It emphasizes the importance of patient-centered outcomes and the road ahead for patient care. Acknowledges contributions of MedaMACS investigators and coordinators.

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Enhancing Heart Failure Patient Care: MedaMACS Progress Report 2014

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  1. Estimating Benefit in Ambulatory Heart Failure PatientsMedaMACS Progress Report 2014 Garrick C. Stewart, MD Brigham and Women’s Hospital

  2. Disclosures • Consulting for Thoratec Corporation

  3. Enrollment Progressthrough 5/1/2014 11 Centers n=83

  4. Baseline Demographics & Clinical Features n=74 Data through 4/1/2014

  5. Clinical Enrollment Datan=74 Data through 4/1/2014

  6. Burden of Comorbid Conditionsn=74 Data through 4/1/2014

  7. MedaMACS Study Encounters 1 Month Re-Look Baseline Telephone Contact Study Site Phone Calls 6 and 18 mos Events (hosp, stroke, transplant, vad, inotropes, death) Meds, Euroqol, NYHA/INTERMACS profile A B Inpt or outpt outpt C D Time Zero One month 1 Yr Face-to-face 18m 2 Yrs Phone Interview 6 mos Phone Interview End Baseline A Baseline B 1-Yr Visit C 2-Yr Visit D Consent 1mo. 12mos 24mos Face-to-face encounters 6MW Gait speed Euroqol+KCCQ VAD Survey Events Treatments 6MW Gait speed Euroqol+KCCQ VAD Survey Risk Scores 6MW Gait speed Euroqol+KCCQ VAD Survey Events Risk Scores Treatments 6MW Gait speed Euroqol+KCCQ VAD Survey Events Risk Scores Treatments

  8. Early Reassessment Uncovers Divergent Patient Trajectories Functional Capacity Quality of Life Δ5 points in EuroQOL VAS n=37 n=53 % %

  9. Patient Feelings About Receiving a VAD • Change From A B • Toward VAD 32% • No Change 49% • Away from VAD 19% % n=53 with paired data

  10. Physician Estimates of Need for Stage D Intervention in Next Year • Change From A B • More likely 20% • No Change 51% • Less likely 29% % n=53 with paired data

  11. Patient Centered Outcomes Beyond Survival

  12. Early Outcomes and Events 83 Baseline A • 52 hospitalizations • 7 deaths • 1 transplant • 3 VADs • 1 consent withdrawn 64 Baseline B 14 6mos f/u Story of the Three VADs… All men, 2 working full time at enrollment, all three obese, two with pulmonary hypertension, ALL in INTERMACS profiles 6/7 at Baseline A

  13. Linking MedaMACS to INTERMACS Mechanical Support Medical Therapy

  14. MedaMACS: The Road Ahead • Patient-centered outcomes beyond survival are required in the “less sick” • Map journey in parallel and in series with MCS • Explore triage points for MCS • Frailty, patient willingness, QOL • Forum for hypothesis-driven research in ambulatory advanced HF population • Inform the conversation with our HF patients

  15. Acknowledgements • MedaMACS investigators and coordinators • UAB team at the DCC • Ryan Cantor

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