Advancing Heart Failure Care: Timely Referral and Life-prolonging Strategies with HeartMate 3  Left Ventricular Assist Device

Excerpt from Article by Dr. Sanjeev Gulati, Radcliffe Cardiology 2025; e1.

Heart failure (HF) remains a leading cause of morbidity and mortality globally, and advanced HF  represents a severe stage of the disease affecting more than 64 million people across the world with  rising prevalence.^1,2 

• Advanced HF is a leading cause of death and is associated with significantly diminished quality of life (QoL), which includes recurrent hospitalizations, debilitating symptoms, such as fatigue and shortness of breath, and reduced functional capacity.^1,2 
• By 2030, it is predicted to cost the US around $70 billion each year.⁷ 

Most of us are very experienced in the role that inotropes play in the short-term management of acute  decompensated HF by enhancing cardiac contractility and alleviating acute symptoms, such as  hypotension, hypoperfusion and severe congestion. However, it is important that we remember that  their benefits are limited to temporary relief, and they do not alter the disease trajectory in advancing  HF.^1,2,3 

• Not only do inotropes offer little survival gain, but their long-term use can also be associated with increased risks of arrhythmias and mortality.^1,2,3 

Fortunately, innovations such as the HeartMate 3 Left Ventricular Assist Device (HM3 LVAD) have  transformed the care of advanced HF patients, offering effective and reliable mechanical circulatory  support with improved hemocompatibility and the potential for myocardial recovery or reversal of HF in  certain cases.^7,8 

I have studied the clinical data and can tell you that the HM3 offers excellent overall outcomes –  

• Real-world survival rates of 85.7% at 1 year and 59.7% at 5 years, serving as a first-line circulatory support for advanced HF⁵ (Figure 3). 
• It improves quality of life while reducing adverse events, including freedom from  gastrointestinal bleeding (72.6% at 5 years), device malfunction (82.9%), and stroke (86.7%).^3,5 

Figure 3: HeartMate 3 LVAD Survival versus Medical Management 

For younger patients (<50 years), the benefits of HM3 LVAD are even more pronounced. 

• With 91.6% survival at 1 year and 72.6% at 5 years.⁵ HM3 prolongs life by enabling myocardial recovery through hemodynamic unloading and adds quality years prior to potential transplantation.^6,7 
• The 2022 AHA/ACC/HFSA heart failure guidelines issued a Class 1A recommendation for LVAD therapy in advanced HF, based on robust survival and outcome data, emphasizing that the risks of long-term inotropes (no survival benefit) far outweigh those of LVAD or transplant when available.¹ 

The Takeaway  

I advise my cardiology colleagues to discontinue inotropes in failing patients using tools like the “Rule of  3,” refer promptly when GDMT wanes, and embrace HM3 for superior outcomes, particularly in  patients under 50, for life prolongation and potential recovery.^1–5 By prioritizing LVAD therapy in this  way, we can extend not just the survival of our patients but also help them thrive because, as I have  shown, every referral advances patient-centered care.³ 

References  

1. Writing Committee Members; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Card Fail 2022;28:e1–167. Crossref | PubMed 
2. Writing Committee, Maddox TM, Januzzi JL Jr, et al. 2021 Update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021;77:772–810. Crossref | PubMed
3. Mehra MR, Gustafsson F. Left ventricular assist devices at the crossroad of innovation in advanced heart failure. J Card Fail 2021;27:1291–4. Crossref | PubMed 
4. Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J 2007;154:260–6. Crossref | PubMed 
5. Meyer DM, Nayak A, Wood KL, et al. The Society of Thoracic Surgeons Intermacs 2024 annual report: focus on outcomes in younger patients. Ann Thorac Surg 2025;119:34–58. Crossref | PubMed 
6. Wever-Pinzon O, Drakos SG, McKellar SH, et al. Cardiac recovery during long-term left ventricular assist device support. J Am Coll Cardiol 2016;68:1540–53. Crossref | PubMed 
7. Maddox TM, Januzzi JL Jr, Allen LA, et al. 2024 ACC expert consensus decision pathway for treatment of heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024;83:1444–88. Crossref | PubMed 

Support provided by Abbott. The Physician(s) worked on Abbott’s behalf. The information is consistent  with applicable FDA guidelines.

Rx Only 

Brief Summary: Prior to using these devices, please review the Instructions For Use for a complete  listing of indications, contraindications, warnings, precautions, potential adverse events and  directions for use. 

HeartMate 3™ Left Ventricular Assist System 

Indications: The HeartMate 3™ Left Ventricular Assist System is indicated for providing short- and long-term mechanical circulatory support (e.g., as bridge to transplant or myocardial recovery, or  destination therapy) in adult and pediatric patients with advanced refractory left  ventricular heart failure and with an appropriate body surface area.  

Contraindications: The HeartMate 3 Left Ventricular Assist System is contraindicated for patients who cannot tolerate, or who are allergic to, anticoagulation therapy. 

Adverse Events: Adverse events that may be associated with the use of the HeartMate 3 Left Ventricular Assist System are: death, bleeding, cardiac arrhythmia, localized infection, right heart failure, respiratory failure, device malfunctions, driveline infection, renal dysfunction, sepsis, stroke, other neurological event (not stroke-related), hepatic dysfunction, psychiatric episode, venous thromboembolism, hypertension, arterial non-central nervous system (CNS) thromboembolism, pericardial fluid collection, pump pocket or pseudo pocket infection, myocardial infarction, wound dehiscence, hemolysis (not associated with suspected device thrombosis) or pump thrombosis. 

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