Search

Background: Because of advances in medical treatment of heart failure, patients are living longer than in previous eras and may approach the need for advanced therapies, including heart transplantation, at older ages. This study assesses practices surrounding heart transplant in older adults (> 70 years) and examines short‐ and medium‐term outcomes. Methods and Results: This study is a retrospective analysis using the United Network for Organ Sharing (UNOS) database from 2010 to 2021. The absolute number of older adults being transplanted is increasing. Older adults were more likely to have had a prior malignancy or ischemic cardiomyopathy and less likely to be on extra‐corporeal membrane oxygenation or have a high UNOS status prior to transplant. Mortality at 1‐year was higher for older adults (27.8% vs. 23.4%), but at 5 years there was no significant difference (22.3% vs. 19.4%.). Older adults were more likely to die of malignancy or infection. Adults under 70 were more likely to die of cardiovascular causes or graft failure. There was less rejection in older adults. Mortality has not changed for older adults transplanted before versus after the 2018 UNOS allocation change. Conclusions: Carefully selected older adults may be considered for heart transplantation, given similar intermediate‐term mortality. [ABSTRACT FROM AUTHOR]

Background: Recent studies suggest the transplantation of Hepatitis C (HCV) hearts from viremic donors is associated with comparable 1 year survival to nonviremic donors. Though HCV viremia is a known risk factor for accelerated atherosclerosis, data on cardiac allograft vasculopathy (CAV) outcomes are limited. We compared the incidence of CAV in heart transplant recipients from HCV viremic donors (nucleic acid amplification test positive; NAT+) compared to non‐HCV infected donors (NAT−). Methods: We retrospectively reviewed annual coronary angiograms with intravascular ultrasound from April 2017 to August 2020 at two large cardiac transplant centers. CAV was graded according to ISHLT guidelines. Maximal intimal thickness (MIT) ≥ 0.5 mm was considered significant for subclinical disease. Results: Among 270 heart transplant recipients (mean age 54; 77% male), 62 patients were transplanted from NAT+ donors. CAV ≥ grade 1 was present in 8.8% of the NAT+ versus 16.8% of the NAT‐ group at 1 year, 20% versus 28.8% at 2 years, and 33.3% versus 41.5% at 3 years. After adjusting for donor age, donor smoking history, recipient BMI, recipient, hypertension, and recipient diabetes, NAT+ status did not confer increased risk of CAV (HR.80; 95% CI.45–1.40, p = 0.43) or subclinical IVUS disease (HR.87; 95% CI.58–1.30, p = 0.49). Additionally, there was no difference in the presence of rapidly progressive lesions on IVUS. Conclusion: Our data show that NAT+ donors conferred no increased risk for early CAV or subclinical IVUS disease following transplantation in a cohort of heart transplant patients who were treated for HCV, suggesting the short‐term safety of this strategy to maximize the pool of available donor hearts. [ABSTRACT FROM AUTHOR]

Introduction: ImmuKnow, an immune cell function assay that quantifies overall immune system activity can assist in post‐transplant immunosuppression adjustment. However, the utility of pre‐transplant ImmuKnow results representing a patient's baseline immune system activity is unknown. This study sought to assess if pre‐transplant ImmuKnow results are predictive of rejection at the time of first biopsy in our cardiac transplant population. Methods: This is a single center, retrospective observational study of consecutive patients from January 1, 2018 to October 1, 2020 who underwent orthotopic cardiac transplantation at NYU Langone Health. Patients were excluded if a pre‐transplant ImmuKnow assay was not performed. ImmuKnow results were categorized according to clinical interpretation ranges (low, moderate, and high activity), and patients were divided into two groups: a low activity group versus a combined moderate‐high activity group. Pre‐transplant clinical characteristics, induction immunosuppression use, early postoperative tacrolimus levels, and first endomyocardial biopsy results were collected for all patients. Rates of clinically significant early rejection (defined as rejection ≥ 1R/1B) were compared between pre‐transplant ImmuKnow groups. Results: Of 110 patients who underwent cardiac transplant, 81 had pre‐transplant ImmuKnow results. The low ImmuKnow activity group was comprised of 15 patients, and 66 patients were in the combined moderate‐high group. Baseline characteristics were similar between groups. Early rejection occurred in 0 (0%) patients with low pre‐transplant ImmuKnow levels. Among the moderate‐ high pre‐transplant ImmuKnow group, 16 (24.2%) patients experienced early rejection (P =.033). The mean ImmuKnow level in the non‐rejection group was the 364.9 ng/ml of ATP compared to 499.3 ng/ml of ATP for those with rejection (P =.020). Conclusion: Patients with low pre‐transplant ImmuKnow levels had lower risk of early rejection when compared with patients with moderate or high levels. Our study suggests a possible utility in performing pre‐transplant ImmuKnow to identify patients at‐risk for early rejection who may benefit from intensified upfront immunosuppression as well as to recognize those where slower calcineurin inhibitor initiation may be appropriate. [ABSTRACT FROM AUTHOR]

Introduction: Implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) for the treatment of heart failure with reduced ejection fraction (HFrEF) should only be considered after 3 to 6 months of optimal guideline-directed medical therapy (GDMT). This includes heart failure approved beta-blockers (HF-BB), ace inhibitors (ACE-I) or angiotensin II receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) for select patients. Our study attempts to characterize the rates of GDMT delivery prior to device implantation in an urban academic hospital and identify potential quality improvement targets. Hypothesis: Prescription rates of HF-BB, ACE-I or ARB, and MRAs will be low prior to device implantation. Methods: We conducted a retrospective analysis of patients who underwent de novo ICD or CRT device implantation at our institution from January 2015 to July 2017. Charts were reviewed to obtain demographics, comorbidities, laboratory, imaging, and medication reconciliation data. We evaluated the rates of any GDMT use on admission as well as rates of two-drug and three-drug regimens. Results: Among 144 patients scheduled for ICD or CRT (mean age 60; 67% male; mean LVEF 27%), 83% were on a HF-BB, 83% were on an ACE-I/ARB, and 31% were on an MRA. Two-drug regimens (HF-BB and ACE-I /ARB) were seen in 69%, and three-drug regimens (HF-BB, ACE-I/ARB, and MRA) in 22%. Only 42% of HF-BBs and 26% of ACE-I/ARB were prescribed at ≥ 50% of the maximal dose. There was no significant difference in GDMT rates between men and women. In addition, the rate of GDMT did not differ from admission to discharge. Conclusion: The data indicate that patients admitted for heart failure device therapy are not receiving optimal GDMT. This presents an opportunity to assess the quality of care delivery at a juncture in the patient's treatment course. [ABSTRACT FROM AUTHOR]

Purpose: Cardiac rehabilitation (CR) is beneficial in heart transplant and left ventricular assist device (LVAD) recipients, but patterns of attendance remain poorly understood. We describe CR adherence and cessation in this population., Methods: We performed a retrospective review of heart transplant and LVAD recipients who attended ≥1 CR session at a tertiary medical center (2013-2022). Complete adherence was defined as attending 36 sessions. Primary reasons for cessation before 36 sessions were recorded. We compared post-operative complications, duration of hospitalization, and readmissions between participants with and without complete adherence using logistic and linear regressions. Among participants with complete adherence, we compared changes in metabolic equivalent of task (MET), exercise time, and peak oxygen uptake using paired sample t tests., Results: There were 137 heart transplant and LVAD recipients (median age 56.9 years, 74% male) who attended CR. Among them, 91% either completed 36 CR sessions or <24 sessions. Among those without complete adherence (n = 74), 72% reported medical reasons, and 15% reported personal reasons for cessation. Compared to those who completed CR, those without complete adherence experienced more post-operative complications (44% vs 24%, P = .02) and major bleeding (23% vs 7%, P = .02) prior to CR. Participants with complete adherence experienced significant improvements in exercise time (142.5 seconds), MET (0.4), and peak oxygen uptake (1.4 mL/kg/min)., Conclusions: Nearly half of heart transplant and LVAD recipients in CR completed all 36 sessions. Those with complete adherence experienced significant improvements in exercise measures, underscoring the important benefits of CR in this population., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Large registries, administrative data, and the electronic health record (EHR) offer opportunities to identify patients with heart failure, which can be used for research purposes, process improvement, and optimal care delivery. Identification of cases is challenging because of the heterogeneous nature of the disease, which encompasses various phenotypes that may respond differently to treatment. The increasing availability of both structured and unstructured data in the EHR has expanded opportunities for cohort construction. This article reviews the current literature on approaches to identification of heart failure, and looks toward the future of machine learning, big data, and phenomapping., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)