1. Estimating Benefit in Ambulatory Heart Failure Patients MedaMACS Progress Report 2014 Garrick C. Stewart, MD Brigham and Women’s Hospital

2. Disclosures Consulting for Thoratec Corporation

3. Enrollment Progress through 5/1/2014 11 Centersn=83

4. Baseline Demographics & Clinical Features Baseline Demographics & Clinical Features n=74 Variable Mean(SD) or % Age, yrs58 (11) Female34 White66 Hispanic9 Working19 Disability52 Data through 4/1/2014 Variable Mean(SD) or % INTERMACS Profile 419 534 641 77 Ejection Fraction, %21 (7)

5. Clinical Enrollment Data Clinical Enrollment Data n=74 Variable% Outpatient status63 Followed >1 yr by center62 Cardiac Hosp prior 12mos 133 234 ≥333 Prior Transplant eval26 Prior DT VAD eval12 Ischemic Etiology31 Prior Cardiac Surgery24 Data through 4/1/2014

6. Burden of Comorbid Conditions Burden of Comorbid Conditions n=74 Variable% Diabetes41 Chronic kidney disease37 Pulmonary hypertension34 Chronic lung disease28 Morbid obesity34 Prior stroke8 History of cancer11 Limited social support18 Repeated non-compliance19 History of smoking37 Data through 4/1/2014

7. MedaMACS Study Encounters Inpt or outpt 1 Month Re-Look Baseline 6 mos Phone Interview 1 Yr Face-to-face 18m 2 Yrs Phone Interview outpt AB C Time Zero D Telephone Contact Study Site Phone Calls 6 and 18 mos Events (hosp, stroke, transplant, vad, inotropes, death) Meds, Euroqol, NYHA/INTERMACS profile One month End 6MW Gait speed Euroqol+KCCQ VAD Survey Events Risk Scores Treatments Baseline B 6MW Gait speed Euroqol+KCCQ VAD Survey Risk Scores 6MW Gait speed Euroqol+KCCQ VAD Survey Events Treatments Baseline A 6MW Gait speed Euroqol+KCCQ VAD Survey Events Risk Scores Treatments Consent 1mo. 12mos 24mos Face-to-face encounters 1-Yr Visit C 2-Yr Visit D

8. Early Reassessment Uncovers Divergent Patient Trajectories % Δ5 points in EuroQOL VAS Functional Capacity Quality of Life n=37n=53

9. Patient Feelings About Receiving a VAD % Change From A  B Toward VAD 32% No Change 49% Away from VAD 19% n=53 with paired data

10. Physician Estimates of Need for Stage D Intervention in Next Year % Change From A  B More likely 20% No Change 51% Less likely 29% n=53 with paired data

11. Patient Centered Outcomes Beyond Survival MedaMACSINTERMACS Events/HospitalizationsStroke, GI bleeding, infection, transplant, worsening heart failure Metabolic ProfileNutrition, renal function, BMI Functional Capacity6 minute walk FrailtyGait speed Quality of LifeEuroQOL-5D, KCCQ, Stress/Coping/Satisfaction Survey

12. Early Outcomes and Events 52 hospitalizations 7 deaths 1 transplant 3 VADs 1 consent withdrawn 83 Baseline A 64 Baseline B 14 6mos f/u Story of the Three VADs… All men, 2 working full time at enrollment, all three obese, two with pulmonary hypertension, ALL in INTERMACS profiles 6/7 at Baseline A

13. Linking MedaMACS to INTERMACS Medical Therapy Mechanical Support

14. MedaMACS: The Road Ahead Patient-centered outcomes beyond survival are required in the “less sick” Map journey in parallel and in series with MCS Explore triage points for MCS –Frailty, patient willingness, QOL Forum for hypothesis-driven research in ambulatory advanced HF population Inform the conversation with our HF patients

15. Acknowledgements MedaMACS investigators and coordinators UAB team at the DCC Ryan Cantor