INTERMACS 1-3 classification significantly increased one-year cardiovascular mortality risk in patients meeting all four HFA-ESC 2018 criteria (HR 1.93; 95% CI 1.18-3.17; p=0.009).
Cohort
Does INTERMACS classification predict one-year cardiovascular mortality in patients with severe heart failure?
1,149 patients with severe heart failure (HF) identified by the presence of at least one 'I-NEED-HELP' criterion from the HELP-HF registry.
INTERMACS classification (1-3 vs 4-7) and fulfillment of all four HFA-ESC 2018 criteria for advanced HF
One-year cardiovascular mortalityhard clinical
The INTERMACS classification significantly impacts one-year cardiovascular mortality in patients with severe HF, with INTERMACS 1-3 indicating a worse prognosis regardless of fulfilling all HFA-ESC 2018 advanced HF criteria.
Abstract Background In patients with severe heart failure (HF) identified by the presence of at least one "I-NEED-HELP" criterion, the 2018 HFA-ESC criteria define a subgroup with a worse prognosis. However, the prognostic significance of the INTERMACS classification in this population remains uncertain. This study analyzes data from the HELP-HF registry, stratifying patients based on INTERMACS class and the fulfillment of all four HFA-ESC 2018 criteria. Objective The primary endpoint was the impact of the INTERMACS classification on one-year cardiovascular mortality. Methods A total of 1,149 patients from the HELP-HF registry with at least one "I-NEED-HELP" criterion were included and categorized into four groups: INTERMACS 1-3 with advanced HF (N=49; 4.3%), INTERMACS 4-7 with advanced HF (N=144; 12.5%), INTERMACS 1-3 without advanced HF (N=55; 4.8%), and INTERMACS 4-7 without advanced HF (N=901; 78.4%). Cox regression models were used to assess the prognostic impact of the INTERMACS classification. Results In patients meeting all four HFA-ESC 2018 criteria, the INTERMACS 1-3 classification was associated with a significantly higher risk of cardiovascular mortality (HR = 1.93; 95% CI 1.18-3.17; p=0.009). Conversely, in patients who did not meet all the criteria, the cardiovascular mortality risk was even higher for the INTERMACS 1-3 classification (HR = 11.53; 95% CI 7.40-17.95; p0.001). Additional analysis showed that in the INTERMACS 4-7 population, the fulfillment of the HFA-ESC 2018 criteria had a stronger prognostic impact than INTERMACS stratification alone (HR = 5.00; 95% CI 3.43-7.29; p0.001). Conclusion The INTERMACS classification significantly impacts one-year cardiovascular mortality in patients with advanced HF according to the HFA-ESC 2018 criteria. Specifically, prognosis worsens in INTERMACS 1-3 patients, highlighting how an acute disease profile has a greater prognostic influence than the advanced HF definition based solely on the HFA-ESC 2018 criteria. In the INTERMACS 4-7 population, the fulfillment of all four HFA-ESC 2018 criteria has a strong prognostic impact, underscoring its importance in this subgroupMorte cardiovascolare
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Modesto Carli
M C Chiarito
A V Villaschi
European Heart Journal
IRCCS Humanitas Research Hospital
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Carli et al. (Sat,) conducted a cohort in severe heart failure (n=1,149). INTERMACS 1-3 classification vs. INTERMACS 4-7 classification was evaluated on one-year cardiovascular mortality (HR 1.93, 95% CI 1.18-3.17, p=0.009). INTERMACS 1-3 classification significantly increased one-year cardiovascular mortality risk in patients meeting all four HFA-ESC 2018 criteria (HR 1.93; 95% CI 1.18-3.17; p=0.009).
www.synapsesocial.com/papers/698586388f7c464f2300a3d1 — DOI: https://doi.org/10.1093/eurheartj/ehaf784.1085