Age and gender differences and factors related to change in health-related quality of life from before to 6 months after left ventricular assist device implantation: Findings from Interagency Registry for Mechanically Assisted Circulatory Support

Abstract

Background Gaps in the literature exist regarding health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) surgery. The purposes of our study were to describe HRQOL over time, by age and gender, and identify risk factors for poor HRQOL early after LVAD implant. Methods Patients (n=7,353) from INTERMACS received a continuous flow LVAD as a primary implant at 133 U.S. hospitals. Of these, 5,640 patients had pre LVAD HRQOL data, and 3,353 patients had 6 month post LVAD HRQOL data. There were 2,748 patients with data at both time periods. HRQOL was measured using the EQ-5D-3L instrument. Data were collected pre-implant and 3 and 6 months post-operatively. Statistical analyses included chi square, t-tests, Pearson correlation coefficients, and multiple regression. Results Overall HRQOL and dimensions of HRQOL improved from before to 6 months after device implant when examined by age and gender. However, younger patients and women reported significantly more problems regarding all dimensions before implant and significantly more problems regarding pain/discomfort and anxiety/depression at both 3 and 6 months after implant. An increase in overall HRQOL from before to 6 months after implant was related to pre implant INTERMACS level 1. Factors related to a decrease in HRQOL from before to 6 months after implant were listed for heart transplant before surgery, co-morbidities, better preoperative HRQOL, adverse events within 6 months after implant, and bridge to transplant moderately likely and unlikely, and NYHA class 4 at 6 months post LVAD (R2=41%). Conclusions Overall HRQOL and dimensions of HRQOL improve in subgroups of patients from before to 6 months after surgery, although differences in improvement exist. Adverse events are risk factors for decreased HRQOL across time and support the ongoing need to improve device technology with the aim of reducing adverse events.

Causes and Consequences of Missing Health-Related Quality of Life Assessments in Patients Who Undergo Mechanical Circulatory Support Implantation

“…The first strategy represents a moderate decrease in scores, while the last strategy represents the “worst case” scenario and provides a lower bound for the distribution of true HRQOL scores. The last strategy was used in previous HRQOL reports from Intermacs 8–10 based on the spread of VAS scores (<10) for Intermacs Profile 1 patients, so we wanted to test the veracity of this approach.…”

“…7 PROs are an integral component of the Intermacs registry, which has previously reported improved HRQOL across time. 8–10 These findings provide important information on outcomes for clinicians to share with advanced heart failure patients considering treatment options, including implantation of left ventricular assist devices (LVADs). However, changes in HRQOL from before to after implant have been related to pre-implant heart failure severity, co-morbidities, implant strategy, and post-implant adverse events, and the optimal approach to handling missing HRQOL data when patients are often missing these assessments due to the severity of their illness requires further elucidation.…”

Quality of life among patients with left ventricular assist device: Comparison of two populations

“…Previous studies have shown that ventricular assist devices improve QoL in older and younger patients from before to six months after LVAD implantation, and older patients report more problems with mobility early after implant than younger patients. [12] In this study, the mean age of the German population was higher than the Turkish population. The German group had significantly lower scores on the KCCQ subscales of physical limitation and symptom frequency, consistent with the literature.…”

Advanced Heart Failure Treatment Options Among the Elderly

“…Finally, Grady et al examined the impact of age (n=493 > 70 years, n=977 < 70 years) among patients enrolled in INTERMACS and found that despite a higher selfreported QOL prior to LVAD implant compared to younger cohorts, older adults demonstrated equivalent gains in QOL metrics 1 year after implantation. 37 While lower QOL score and rehospitalization after LVAD were important variables in subsequent QOL scores, age did not influence this metric.…”