INTERMACS classification for advanced heart failure
INTERMACS classification for advanced heart failure
INTERMACS classification for advanced heart failure was developed as a sub classification for advanced heart failure, typically for those in advanced NYHA Functional Class III and IV. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) developed this classification with seven clinical profiles and an arrhythmia modifier. This was to allow optimal selection of patients for medical and pacing therapies, cardiac transplantation and mechanical circulatory support. They found that 80% of current devices are being used in 2 profiles with the highest level of clinical compromise. Two more modifiers were added for those on temporary circulatory support devices in the hospital and for frequent rehospitalization of patients being treated at home. So finally, it became 7 profiles and 3 modifiers. Unlike in the usual types of classifications, in the INTERMACS classification, profile 1 is the most severe. It is critical cardiogenic shock with life threatening hypotension despite escalating inotropic support, with critical organ hypoperfusion. This is associated with worsening acidosis and/or lactate levels. This has been called “Crash and burn”. Profile 2 is one of progressive decline with declining function despite intravenous inotropic support with worsening renal function, nutritional depletion and inability to restore volume balance. This profile has been nicknamed “Sliding on inotropes” Profile 3 is stable, but inotrope dependent. They have stable blood pressure and organ function on continuous intravenous inotropic support. Some may be on a temporary mechanical support device. This group demonstrates repeated failure to wean from support due to recurrent symptomatic hypotension or renal dysfunction. This profile is called “Dependent stability” Profile 4 is with resting symptoms but can be stabilized close to normal volume status. They experience daily symptoms of congestion at rest or during activities of daily living. Diuretic doses fluctuate at very high levels. They require intensive management and surveillance for compliance to therapy. Profile 5 is exercise intolerant group. They are comfortable at rest and with activities of daily life, but unable to engage in any other activity and are mostly home bound. They have only marginal changes in nutritional status and organ function. Profile 6 is exertion limited, without evidence of fluid overload. They are comfortable at rest, with activities of daily living and minor activities outside of home. Profile 7 is advanced NYHA class III. This group does not have current or recurrent episodes of unstable fluid balance. They live comfortably with meaningful activity limited to mild physical exertion. Modifier profiles as mentioned earlier are TCS with temporary circulatory support in hospital, A with arrhythmia including frequent ICD shocks or external defibrillator shocks, and FF or Frequent Flyer requiring frequent emergency visits, hospitalization for diuretics or temporary intravenous vasoactive therapy. Various treatment strategies for patients with an INTERMACS profile 1 have been reviewed in another article. The strategies reviewed were intra-aortic balloon pump (IABP), Impella 2.5 and 5.0, TandemHeart, venoarterial extracorporeal membrane oxygenation (VA ECMO) and CentriMag/BioMedicus Centrifugal Pumps. Selection of device will depend on patient’s clinical status, availability of the device and the time needed to place the device. Impella 2.5 and TandemHeart can be placed in the cardiac catheterization laboratory. Impella 2.5 may provide only partial unloading of the left ventricle, while TandemHeart needs placement of a transseptal inflow catheter. Here are a couple of important journal references.
Content
0.729 -> INTERMACS classification for advanced heart
failure was developed as a sub classification
6.67 -> for advanced heart failure, typically for
those in advanced NYHA Functional Class III
14.95 -> and IV.
15.95 -> Interagency Registry for Mechanically Assisted
Circulatory Support (INTERMACS) developed
18.269 -> this classification with seven clinical profiles
and an arrhythmia modifier.
25.3 -> This was to allow optimal selection of patients
for medical and pacing therapies, cardiac
31.429 -> transplantation and mechanical circulatory
support.
34.969 -> They found that 80% of current devices are
being used in 2 profiles with the highest
43.12 -> level of clinical compromise.
45.32 -> Two more modifiers were added for those on
temporary circulatory support devices in the
52.1 -> hospital and for frequent rehospitalization
of patients being treated at home.
58.37 -> So finally, it became 7 profiles and 3 modifiers.
65.55 -> Unlike in the usual types of classifications,
in the INTERMACS classification, profile 1
70.4 -> is the most severe.
72.03 -> It is critical cardiogenic shock with life
threatening hypotension despite escalating
80.01 -> inotropic support, with critical organ hypoperfusion.
85.01 -> This is associated with worsening acidosis
and/or lactate levels.
93.11 -> This has been called “Crash and burn”.
96.63 -> Profile 2 is one of progressive decline with
declining function despite intravenous inotropic
105.14 -> support with worsening renal function, nutritional
depletion and inability to restore volume
112.46 -> balance.
113.62 -> This profile has been nicknamed “Sliding
on inotropes”
119.33 -> Profile 3 is stable, but inotrope dependent.
124.79 -> They have stable blood pressure and organ
function on continuous intravenous inotropic
132.78 -> support.
133.78 -> Some may be on a temporary mechanical support
device.
138.95 -> This group demonstrates repeated failure to
wean from support due to recurrent symptomatic
145.489 -> hypotension or renal dysfunction.
147.64 -> This profile is called “Dependent stability”
Profile 4 is with resting symptoms but can
157.73 -> be stabilized close to normal volume status.
161.76 -> They experience daily symptoms of congestion
at rest or during activities of daily living.
169.27 -> Diuretic doses fluctuate at very high levels.
174.4 -> They require intensive management and surveillance
for compliance to therapy.
180.519 -> Profile 5 is exercise intolerant group.
186.299 -> They are comfortable at rest and with activities
of daily life, but unable to engage in any
193.72 -> other activity and are mostly home bound.
197.099 -> They have only marginal changes in nutritional
status and organ function.
203.019 -> Profile 6 is exertion limited, without evidence
of fluid overload.
209.129 -> They are comfortable at rest, with activities
of daily living and minor activities outside
216.799 -> of home.
218.129 -> Profile 7 is advanced NYHA class III.
222.599 -> This group does not have current or recurrent
episodes of unstable fluid balance.
229.3 -> They live comfortably with meaningful activity
limited to mild physical exertion.
237.23 -> Modifier profiles as mentioned earlier are
TCS with temporary circulatory support in
244.18 -> hospital, A with arrhythmia including frequent
ICD shocks or external defibrillator shocks,
252.09 -> and FF or Frequent Flyer requiring frequent
emergency visits, hospitalization for diuretics
258.57 -> or temporary intravenous vasoactive therapy.
263.71 -> Various treatment strategies for patients
with an INTERMACS profile 1 have been reviewed
269.25 -> in another article.
270.87 -> The strategies reviewed were intra-aortic
balloon pump (IABP), Impella 2.5 and 5.0,
