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INTERMACS Profile Calculator (Advanced HF, LVAD Consideration)

  • Is the patient in cardiogenic shock requiring immediate mechanical or inotropic support?
  • Is the patient dependent on continuous intravenous inotropes to maintain perfusion?
  • Does the patient have resting symptoms (dyspnea, fatigue, or congestion at rest) despite medical therapy?
  • Has the patient been hospitalized for heart failure within the past month?
  • Can the patient perform minimal activity (such as walking indoors) without symptoms?
  • INTERMACS Profile: Explanation and Clinical Context
    The INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profile system is a standardized classification scheme to describe the clinical severity of advanced heart failure. It stratifies patients into seven profiles (1–7) ranging from critical cardiogenic shock to advanced but stable NYHA class III disease.

    Profiles 1–3 represent patients with high-acuity, end-stage heart failure requiring urgent or elective mechanical circulatory support (MCS) or LVAD implantation, while Profiles 4–5 are stable but symptomatic and often evaluated for elective advanced therapy. Profiles 6–7 describe patients who remain stable under optimal medical management.

    The INTERMACS classification has become an essential communication and decision-making tool to guide LVAD timing, transplant eligibility, and expected outcomes. Studies have shown that patients implanted with LVAD at lower INTERMACS profiles (1–2) have higher early mortality, whereas elective implantation (profiles 3–4) yields the best long-term survival.

    Reference:
    Stevenson LW, Pagani FD, Young JB, et al. INTERMACS profiles of advanced heart failure: The current picture. J Heart Lung Transplant. 2009;28(6):535–541. doi:10.1016/j.healun.2009.02.015
    Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34(12):1495–1504.
    Rogers JG, Aaronson KD, Boyle AJ, et al. Continuous-flow LVAD outcomes across INTERMACS profiles. J Am Coll Cardiol. 2010;55(17):1826–1834.