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Outcomes With Current Devices Are We Really Improving?

Outcomes With Current Devices Are We Really Improving?. 2005. ISHLT. J Heart Lung Transplant 2005;24:1182-1187. ISHLT/MCSD Analysis, n=655. Intention to Treat n % of 655 Bridge to transplant 513 78.3% Bridge to recovery 35 5.3%

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Outcomes With Current Devices Are We Really Improving?

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  1. Outcomes With Current Devices Are We Really Improving?

  2. 2005 ISHLT J Heart Lung Transplant 2005;24:1182-1187 ISHLT/MCSD Analysis, n=655 Intention to Treat n % of 655 Bridge to transplant 513 78.3% Bridge to recovery 35 5.3% Destination Therapy 78 11.9% Not specified 29 4.4% Total 655 100%

  3. INTERMACS: March 2006 – March 2008, n = 483 Device Strategy at Implant % Bridge to Recovery 27 5 % Bridge to Transplant 460 80 % Destination Therapy 90 15 % Total 483 100 %

  4. Quality of Live

  5. ISHLT/MCSD Analysis Infection Episodes (n=668) 175 Cumulative Events per 100 Patients Bleeding Episodes (n=396) 75 Thromboembolism Episodes (n=86) 18 Months after Device Implant

  6. INTERMACS first DATABASEBUT: • No standardized INDICATIONS • NO consensus between different CENTERS • Different VADs

  7. Personal experience with INCOR(14 pts) 5 transplanted 9 non trasplanted 4 died 1 perioperative 5 months 14 months 35 months 4 on going 1 recovery

  8. Personal experience with INCOR • Less neurological problems (more aggressive anticoagulation protocol) • High infective risk • Good Quality of Live

  9. Indications Devices Cultural IMPROVING

  10. INDICATIONS SHORT-TERM LONG-TERM • Bridge to Recovery • Bridge to Bridge • Bridge to TxC • Destination Therapy

  11. VAD as DIALYSIS

  12. VAD as CRT

  13. CULTURAL IMPROOVEMENT

  14. Patients Is it only a prosthesis?

  15. VAD CANDIDATES 282 CHF pts tx Medical therapy No Tx 3.5%

  16. VAD CANDIDATES in ITALY 129309 140000 120000 63985 pts x 3.5% = 2239 pts 100000 80000 60000 43183 40000 18661 20000 164 169 164 1644 0 < 1 1 - 14 15 - 24 25 - 44 45 - 64 65 - 74 >= 75

  17. Health providers Devices Batteries Hospital Ambulatory Follow up and manteinance VADs had to be paid for 3-5 years Who pays?

  18. today And tomorrow?

  19. The Value of Medical Spendingin the United States, 1960 –2000N Engl J Med 2006;355:920-7. Causes of Increases in Life Expectancy among Newborns, 1960–2000. Cause Increase in Life Relative Expectancy Contribution yr % Reduction in rate of death from cardiovascular disease 4.88 70 Reduction in rate of death in infancy 1.35 19 Reduction in rate of death from external causes 0.36 5 Reduction in rate of death from pneumonia or influenza 0.28 4 Reduction in rate of death from cancer 0.19 3 Total 6.97 100

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