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2.03 (0.99-4.13)

Overall, REMATCH patients have a higher mortality than is measured for AIDS or breast, colon, and lung cancer. Based on REMATCH results, LVAD systems will prevent 270 deaths annually per 1000 patients treated — four times as effective as beta blockers and ace inhibitors, with a quality of life similar to ambulatory heart failure patients (Table A.4). All of the evidence suggests that these factors could improve, with fewer adverse events, following further research and clinical experience.

Table A.4. REMATCH Results for LVAD Systems

LVAD Mortality Impact

Quality of Life

Adverse Events

LVAD Rx would avert 270 deaths annually per 1000 patients treated

Improved compared to ESHF, yet normalcy not restored

LVAD morbidity still considerable

Nearly 4 times the observed impact of beta-blockers and ACEI (70 deaths prevented per 1000 patients)

Physical function scores similar to hemodialysis and ambulatory heart failure

Infections and mechanical failure obvious targets for device and management improvement

Magnitude of effect commensurate with complexity of intervention

Emotional role scores better than clinical depression and similar to ambulatory heart failure

Rate of neurological events encouraging

The potential of LVAD systems is highlighted in the following two examples of patients from the REMATCH trial. The first example is a 35-year-old women. Following her implant, she has married and is enjoying her husband, home, and dogs. The second patient is a 67-year-old man who collapsed on the golf course. He now claims he is playing better golf than ever against those "40-year-old flat bellies."

This program would not have occurred without priority-setting by Congress. The clinical need is still substantial. Without sustained public support, the needed research and development capacity would not have materialized. NBIC holds even greater promise but will not achieve its potential without setting some national long-term research objectives.

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