Heart Failure

35 Table 22. INTERMACS Profiles Profile a Profile Description Features 1 Critical cardiogenic shock ("crash and burn") Life-threatening hypotension and rapidly escalating inotropic/pressor support, with critical organ hypoperfusion oen confirmed by worsening acidosis and lactate levels. 2 Progressive decline ("sliding fast" on inotropes) "Dependent" on inotropic support but nonetheless shows signs of continuing deterioration in nutrition, renal function, fluid retention, or other major status indicator. Can also apply to a patient with refractory volume overload, perhaps with evidence of impaired perfusion, in whom inotropic infusions cannot be maintained due to tachyarrhythmias, clinical ischemia, or other intolerance. 3 Stable but inotrope- dependent Clinically stable on mild-moderate doses of intravenous inotropes (or has a temporary circulatory support device) aer repeated documentation of failure to wean without symptomatic hypotension, worsening symptoms, or progressive organ dysfunction (usually renal). 4 Resting symptoms on oral therapy at home Patient who is at home on oral therapy but frequently has symptoms of congestion at rest or with activities of daily living (dressing or bathing ). He or she may have orthopnea, shortness of breath during dressing or bathing, gastrointestinal symptoms (abdominal discomfort, nausea, poor appetite), disabling ascites, or severe lower-extremity edema. 5 Exertion-intolerant ("housebound") Patient who is comfortable at rest but unable to engage in any activity, living predominantly within the house or housebound. 6 Exertion-limited ("walking wounded") Patient who is comfortable at rest without evidence of fluid overload but who is able to do some mild activity. Activities of daily living are comfortable, and minor activities outside the home such as visiting friends or going to a restaurant can be performed, but fatigue results within a few minutes or with any meaningful physical exertion. 7 Advanced NYHA class III Patient who is clinically stable with a reasonable level of comfortable activity, despite a history of previous decompensation that is not recent. is patient is usually able to walk more than a block. Any decompensation requiring intravenous diuretics or hospitalization within the previous month should make this person a patient with profile 6 or lower. a Modifier options: Profiles 3–6 can be modified with the designation FF (frequent flyer) for patients with recurrent decompensations leading to frequent (generally at least 2 in last 3 months or 3 in last 6 months) emergency department visits or hospitalizations for intravenous diuretics, ultrafiltration, or brief inotropic therapy. Profile 3 can be modified in this fashion if the patient is usually at home. If a profile 7 patient meets the definition of FF, the patient should be moved to profile 6 or worse. Other modifier options include A (arrhythmia), which should be used in the presence of recurrent ventricular tachyarrhythmias contributing to the overall clinical course (eg, frequent ICD shocks or requirement of external defibrillation, usually more than twice weekly); or TCS (temporary circulatory support) for hospitalized patients with profiles 1–3. Adapted from Stevenson LW, et al. J Heart Lung Transplant. 2009;28:535-541.

• Cover