Purpose: Intermacs Patient Profiles (IPP) are subjective assessments of patient acuity of illness assigned at the time of durable left ventricular assist device implantation (dLVAD). Previous studies have demonstrated provider variability with IPP assignment. We developed a novel algorithm to derive a patient's IPP acuity of illness to assist clinicians with IPP assignment.

Purpose While improved health-related quality of life (HRQOL) is an important durable left ventricular assist device (LVAD) implant outcome, 50% of HRQOL data are missing in the STS-Intermacs registry. Pre-implant HRQOL missingness may reflect patient and hospital characteristics and thus serve as a novel hospital quality metric. We hypothesized that hospital pre-implant HRQOL missingness independently predicts 90-day outcomes. Methods The study cohort included 14,063 patients receiving a primary LVAD (4/2012 - 8/2017) with or without RVAD at 169 hospitals. Patient risk factors of pre-implant HRQOL (using the EQ-5D visual analog scale) missingness were examined by a stepwise logistic model. Direct standardization method was used to calculate hospital adjusted missing rates using a mixed effects logistic model. Hospitals were dichotomized as low/high based on median adjusted missing rates. Cox models, adjusting for patient risk, were used to associate a hospital's pre-implant HRQOL adjusted missing rate with 90-day infection, renal dysfunction and mortality. Results Patients with missing pre-implant EQ-5D (47.1% of patients) were younger (mean age: 56.2 vs. 57.9), more often non-White (36.3% vs. 32.0%), with an Intermacs Profile 1 (25.1% vs. 7.3%), compared to those with complete EQ-5D (all p<.0001). Probability of 90-day composite outcome differed by high and low adjusted missing rate hospitals (p<.0001, Figure). A 10% increase in hospital EQ-5D adjusted missingness was significantly associated with 90-day infection (HR: 1.05; 95%CI: 1.03-1.07), infection mortality (HR: 1.09; 95%CI, 1.01-1.18), renal dysfunction (HR: 1.03; 95%CI: 1.004-1.05) but not all-cause mortality (adjusted HR: 1.01; 95%CI, 0.98-1.04). Conclusion Higher hospital adjusted pre-implant HRQOL missingness was predictive of higher 90-day infection, infection mortality and renal dysfunction. Hospital pre-implant HRQOL missingness may serve as a novel LVAD quality metric.