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Karason K, Lund LH, Dalén M, Björklund E, Grinnemo K, Braun O, Nilsson J, van der Wal H, Holm J, Hübbert L, Lindmark K, Szabo B, Holmberg E, Dellgren G. Randomized trial of a left ventricular assist device as destination therapy versus guideline-directed medical therapy in patients with advanced heart failure. Rationale and design of the SWEdish evaluation of left Ventricular Assist Device (SweVAD) trial. Eur J Heart Fail 2020; 22:739-750. [PMID: 32100946 DOI: 10.1002/ejhf.1773] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Patients with advanced heart failure (AdHF) who are ineligible for heart transplantation (HTx) can become candidates for treatment with a left ventricular assist device (LVAD) in some countries, but not others. This reflects the lack of a systematic analysis of the usefulness of LVAD systems in this context, and of their benefits, limitations and cost-effectiveness. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized, non-blinded, multicentre trial that will examine the impact of assignment to mechanical circulatory support with guideline-directed LVAD destination therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs. guideline-directed medical therapy (GDMT) on survival in a population of AdHF patients ineligible for HTx. METHODS A total of 80 patients will be recruited to SweVAD at the seven university hospitals in Sweden. The study population will comprise patients with AdHF (New York Heart Association class IIIB-IV, INTERMACS profile 2-6) who display signs of poor prognosis despite GDMT and who are not considered eligible for HTx. Participants will be followed for 2 years or until death occurs. Other endpoints will be determined by blinded adjudication. Patients who remain on study-assigned interventions beyond 2 years will be asked to continue follow-up for outcomes and adverse events for up to 5 years. CONCLUSION The SweVAD study will compare survival, medium-term benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will provide a valuable reference point to guide destination therapy strategies for patients with AdHF ineligible for HTx.
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Affiliation(s)
- Kristjan Karason
- Departments of Cardiology and Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars H Lund
- Departments of Cardiology and Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Dalén
- Departments of Cardiology and Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Björklund
- Departments of Cardiology and Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Karl Grinnemo
- Departments of Cardiology and Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Oscar Braun
- Departments of Cardiology and Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Johan Nilsson
- Departments of Cardiology and Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Henriette van der Wal
- Departments of Cardiology and Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden
| | - Jonas Holm
- Departments of Cardiology and Cardiothoracic Surgery, Linköping University Hospital, Linköping, Sweden
| | - Laila Hübbert
- Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Krister Lindmark
- Department of Cardiology, Umeå University Hospital, Umeå, Sweden
| | - Barna Szabo
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Erik Holmberg
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Dellgren
- Departments of Cardiothorax Surgery and Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
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