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Further, the length of stay for the index hospitalization was 27 days shorter in the less sick patients. Eckman et al25 grouped LVAD patients into those treated with inotropes before implant (INTERMACS 1–3) and those who were not (profile 4–6). Median length of stay was 29 days for the first group versus 16 days for noninotrope dependent patients. Direct costs were $216 902 versus $175 397, respectively. Thus, refined candidate selection that minimizes the number of patients with critical cardiogenic shock and end-organ dysfunction can reasonably be anticipated to reduce index hospitalization length of stay, mortality, and cost of mechanically assisted circulation.