Existing Non-cardiac Comorbidities Negatively Impact Quality of Life Gains After Left Ventricular Assist Device Implant

Abstract

Introduction The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) collects quality of life data via Kansas City Cardiomyopathy Questionnaire (KCCQ-12) and Visual Analog Score (VAS). These data are collected pre- and post-LVAD implantation. Though previous studies have shown that overall health-related quality of life (HRQoL) improves at one year after implantation, specific factors that predict a higher quality of life have not been identified. Hypothesis Self-perceived quality of life after LVAD implant is influenced by demographics and preexisting comorbidities. Methods We identified 118 patients in the INTERMACS database who received a LVAD at our institution. Of these, 26 patients completed the KCCQ-12 questionnaire and 32 patients completed VAS at 1-year follow up. An exploratory data analysis was conducted using descriptive statistics, correlation tests, and non-parametric comparison tests such as Wilcoxon rank-sum to identify important trends and predictors for changes in HRQoL. Multiple variables (patient characteristics, clinical data) were tested independently against the KCCQ-12 and VAS scores at one year and with the absolute change in these scores over a one-year period. Due to low sample size, we were not able to perform a multivariate model. Results New York Heart Association Class IV symptoms at baseline (p=0.01) were predictive of large gains in VAS scores at one year. Frailty, although not reaching significance, may be associated with smaller magnitudes of improvement in KCCQ at one year (p=0.067). The presence of peripheral vascular disease at pre-implant predicts a lower VAS score at one year (p=0.03). Demographic factors such as age, sex, and marital status at implant did not predict higher post implant quality of life by either VAS or KCCQ. Conclusion Existing non-cardiac comorbidities should be taken into consideration when assessing the health related quality of life benefit of LVAD implantation.