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INTERMACS Profiles — EECC MCQ

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HardHeart FailureINTERMACS ProfilesEECC

A 70-year-old man with advanced HFrEF (LVEF 15%) on maximal GDMT, CRT-D, and recent IV inotrope dependency discusses his prognosis. His cardiology team introduces the concept of 'Interagency Registry for Mechanically Assisted Circulatory Support' (INTERMACS) profiles. What is the INTERMACS classification?

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Correct answer: E — INTERMACS profiles classify advanced HF severity from 1 (critical cardiogenic shock — 'crash and burn') to 7 (advanced NYHA III — 'placeholder'); profiles 1-3 indicate patients who may benefit from LVAD or transplant, while profiles 4-7 suggest ongoing GDMT optimisation

INTERMACS profiles provide granular classification of advanced HF beyond NYHA: Profile 1 ('crash and burn'): cardiogenic shock on multiple IV inotropes/vasopressors ± MCS; Profile 2 ('sliding on inotropes'): declining despite IV inotropes; Profile 3 ('dependent stability'): stable on IV inotropes but unable to wean; Profile 4 ('frequent flyer'): recurrent decompensations requiring hospitalisation; Profile 5 ('housebound'): comfortable at rest, unable to perform any physical activity; Profile 6 ('walking wounded'): limited exertion, fatigue with ADLs; Profile 7 ('placeholder'): advanced NYHA III, stable. The ESC HF Guidelines use INTERMACS to guide advanced therapy decisions: profiles 1-3 → LVAD as bridge to transplant/decision/candidacy; profiles 4-7 → optimise GDMT, consider LVAD as destination therapy if no transplant option. The classification also predicts post-LVAD outcomes (profile 1-2 have higher post-implant mortality than 3-4).

Reference: ESC (2023): HF Guidelines; INTERMACS Classification