Recommendations for the management of non-cardiac comorbidities
Recommendation   Class   Level   References
Malignancies
Evaluation for malignancies is recommended.  I  A
In patients with a proven malignancy and an expected survival of <1 year, implantation of long-term mechanical circulatory support is not recommended.  III  C
Pulmonary hypertension
Invasive haemodynamic assessment of pulmonary vascular resistance is recommended.  I  C  [107]
In heart transplant candidates, normalization of elevated pulmonary vascular resistance in patients on long-term mechanical circulatory support should be considered.  IIa  B  [108, 109, 130, 131]
Cardiac cachexia
Assessment of frailty and nutritional status using a frailty score and/or prognostic nutrition index prior to implantation of long-term mechanical circulatory support may be considered.  IIb  C  [48, 96]
Renal dysfunction
Implantation of long-term mechanical circulatory support should be considered in case of reversible secondary renal dysfunction.  IIa  C  [37, 56, 71, 103]
Implantation of long-term mechanical circulatory support may be considered in patients on chronic haemodialysis.  IIb  C  [37, 56, 103]
Neurological function and disorders
Careful neurological examination is recommended for all candidates for implantation of long-term mechanical circulatory support including assessment of dementia and mental status.  I  C  [104, 132]
Multidisciplinary evaluation of prognosis of survival and morbidity of patients with neuromuscular disorders is recommended.  I  C  [133]
Adherence (medical therapy, alcohol, tobacco, psychological, psychiatric and social derangement)
Screening for psychological and psychiatric (including cognitive function) disorders and substance abuse is recommended.  I  C  [104]
It is recommended that adherence (tobacco, alcohol and substance abuse), psychosocial risks and familial support be evaluated.  I  C  [134]
In patients with frailty, psychiatric or neurological disorders, evaluation of their ability to operate the device is recommended.  I  C
Vascular disease
Screening for peripheral vascular disease is recommended.  I  C  [67]
Coagulation and haematological disorders
Evaluation of all long-term mechanical circulatory support candidates for coagulopathies and hypercoagulable states (e.g. thrombophilia) is recommended.  I  C  [135]
In patients with thrombocytopenia after exposure to heparin, testing for heparin-induced thrombocytopenia should be considered.  IIa  C  [136]
Respiratory considerations
Spirometry as part of the patient work-up should be considered.  IIa  C  [25, 37, 137]
Preoperative thoracic imaging should be considered as part of the overall risk/benefit evaluation.  IIa  C  [25, 37, 137]
Diabetes
Screening for diabetes mellitus (including end-organ damage) before implant of long-term mechanical circulatory support is recommended. For patients with poorly controlled diabetes, consultation with a diabetologist is recommended.  I  C
Implantation of long-term mechanical circulatory support in patients with diabetes with severe end-organ complications is not recommended.  III  C
Gastrointestinal disorders
Gastrointestinal bleeding in patients 50 years or older: faecal occult blood testing, gastroscopy and endoscopy should be considered.  IIa  C  [116, 117]
Pregnancy
Contraception in women of childbearing age after implant of long-term mechanical circulatory support is recommended.  I  C
Long-term mechanical circulatory support in the setting of pregnancy is a multidisciplinary challenge and may be considered.  IIb  C  [128, 129]