Survival Outcomes in Middle-Aged and Older Patients With Advanced Heart Failure (JACC Heart Failure September 2026)-Article: Survival Outcomes in Middle-Aged and Older Patients With Advanced Heart Failure

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This study compared outcomes of HeartMate 3 (HM3) LVAD therapy and heart transplantation (HT) in middle-aged patients (50–64 years) and older adults (65+ years) with advanced heart failure, using propensity-matched data from the MOMENTUM 3 trial and the UNOS registry.<br /><br />Key findings:<br />- When survival was measured from the time of treatment, HT had better 2-year survival than HM3 in both age groups.<br />  - Middle-aged: 90.7% HT vs 83.8% HM3<br />  - Older: 87.5% HT vs 77.7% HM3<br />- However, when the analysis started at transplant listing and included waitlist time, HM3 performed better:<br />  - In middle-aged patients, HM3 had higher 2-year survival than survival free from death or delisting due to deterioration among HT candidates.<br />  - In older adults, HM3 also showed numerically better survival, though this was not statistically significant.<br /><br />Adverse events differed by therapy:<br />- Infection-related hospitalizations were significantly more common after HT than after HM3 in both age groups.<br />- Renal dysfunction requiring dialysis was similar between groups.<br />- In older adults, HM3 was associated with more stroke events than HT.<br /><br />Overall, the study shows that HT offers superior survival after the transplant occurs, but HM3 may provide better real-world survival when the uncertainty and risk of the waitlist are included. The authors conclude that treatment choice should account for wait time, age, and patient-specific risks when discussing advanced heart failure therapies.

Meta Tag

Concept HeartMate 3

Concept Heart Transplantation

Concept End-Stage Heart Failure

Concept Survival Outcome

Concept Propensity Score Matching

Keywords

HeartMate 3

LVAD

heart transplantation

advanced heart failure

propensity-matched

MOMENTUM 3

UNOS registry

survival outcomes

waitlist time

adverse events

HeartMate 3

Heart Transplantation

End-Stage Heart Failure

Survival Outcome

Propensity Score Matching