TOPLINE

Younger patients who received the HeartMate 3 left ventricular assist device (LVAD) had better survival rates and fewer bleeding events but experienced hemorrhagic stroke more often. Older patients experienced infections, including sepsis, more frequently.

METHODOLOGY

• The MOMENTUM 3 randomized controlled trial demonstrated promising outcomes with the HeartMate 3 device. Researchers pooled data from the cohorts of the trial and analyzed how age affected key outcomes.
• They included 2200 patients who received the HeartMate 3 LVAD at multiple US centers between September 2014 and October 2018.
• Patients were stratified into four age groups: younger than 50 years (n = 432), 50-59 years (n = 504), 60-69 years (n = 752), and 70 years or older (n = 512).
• The primary endpoint was 2-year survival. The secondary endpoint was 2-year survival free of the composite outcome of disabling stroke or reoperation for device malfunction.
• Researchers also assessed the occurrence of bleeding, infections, and strokes and evaluated quality-of-life scores and the 6-minute walk distance.

TAKEAWAY

• The 2-year survival rates decreased with age from 89.1% among patients younger than 50 years to 72.8% among those aged 70 years or older. Compared with patients younger than 50 years, patients aged 60-69 years and those aged 70 years or older had a 1.76-fold and 2.24-fold higher risk for death, respectively (P < .01 for both).
• The 2-year rates of survival free of disabling stroke or reoperation declined with age, with patients aged 70 years or older having a 1.46-fold greater risk for the composite outcome than those younger than 50 years (P = .028). Hemorrhagic stroke was most common in the youngest subgroup, whereas ischemic stroke rates were similar across age groups.
• Older patients had higher rates of major bleeding and gastrointestinal bleeding than patients younger than 50 years (P < .001). Localized infections and sepsis were more frequent in patients in the oldest vs youngest subgroup (P < .05 for both), whereas driveline infections were less frequent.
• Scores for quality of life improved in all age groups, with older patients having higher absolute scores at baseline and follow-up. The 6-minute walk distance also improved in all groups, with the largest gains in the youngest subgroup.

IN PRACTICE

“These results suggest that LVAD can be considered as a primary choice in advanced HF treatments for younger patients, whether as a bridge to recovery or transplantation,” the researchers of the study wrote.

“We would caution against interpreting these findings as evidence that age alone should drive therapeutic sequencing. A 45-year-old patient who experiences a hemorrhagic stroke after LVAD implantation and a 75-year-old patient who develops recurrent sepsis may both be counted as survivors. Yet their future therapeutic options are fundamentally different. This distinction is not fully captured by survival curves,” Mahwash Kassi, MD, and Ashrith Guha, MD, wrote in an editorial comment.

SOURCE

The study was led by Boaz Elad, MD, Columbia University Irving Medical Center, New York City. It was published online on June 30 in JACC: Heart Failure.

LIMITATIONS

The groups had key differences at baseline, suggesting that age alone did not explain outcomes. The study was not specifically powered for the subgroup analysis. The analysis was limited to 2 years, limiting long-term assessment.

DISCLOSURES

The MOMENTUM 3 studies were supported by Abbott, which also manufactured the HeartMate 3 device. Several authors reported receiving institutional payments for consulting and speaking, personal fees, clinical trial funds, and grants from Abbott. Three authors reported being employees of Abbott. Some authors reported having similar ties with other commercial and noncommercial entities; details were provided in the original manuscript.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.