TY - JOUR
T1 - 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
T2 - Findings from Interagency Registry for Mechanically Assisted Circulatory Support
AU - Grady, Kathleen L.
AU - Sherri Wissman, Wissman
AU - Naftel, David C.
AU - Myers, Susan
AU - Gelijins, Annetine
AU - Moskowitz, Alan
AU - Pagani, Francis D.
AU - Young, James B.
AU - Spertus, John A.
AU - Kirklin, James K.
N1 - Funding Information:
D.C.N. is a consultant for HeartWare and Thoratec Corporations. J.A.S. receives grant support from American College of Cardiology Foundation, Amorcyte, Lilly, Genentech, and Gilead, owns the copyright to the Kansas City Cardiomyopathy Questionnaire, and serves as a consultant to the Scientific Advisory Board of United Healthcare, Amgen, and Janssen. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
Funding Information:
This work was sponsored by the National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI), and Registry of Mechanical Circulatory Support Devices for End-Stage Heart Failure (INTERMACS), Contract No. HHSN268200548198C. K.L.G. receives NHLBI and National Institute on Aging funding. J.A.S. receives grant support from the National Institutes of Health and Patient-Centered Outcomes Research Institute.
Publisher Copyright:
© 2016 International Society for Heart and Lung Transplantation. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - 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 the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database received a continuous-flow LVAD as a primary implant at 133 United States hospitals. Of these, 5,640 patients had pre-LVAD HRQOL data, 3,353 patients had 6-month post-LVAD HRQOL data, and 2,748 patients had data at both times. HRQOL was measured using the EQ-5D-3L (Euro-Qol) instrument. Data were collected pre-implant and 3 and 6 months post-operatively. Statistical analyses included chi-square test, t-test, Pearson correlation coefficients, and multiple regression analysis. 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 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, comorbidities, better preoperative HRQOL, adverse events within 6 months after implant, bridge to transplant moderately likely and unlikely, and New York Heart Association Functional Classification IV at 6 months after LVAD (R2 = 41%). Conclusions Overall HRQOL and dimensions of HRQOL improve in sub-groups 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.
AB - 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 the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database received a continuous-flow LVAD as a primary implant at 133 United States hospitals. Of these, 5,640 patients had pre-LVAD HRQOL data, 3,353 patients had 6-month post-LVAD HRQOL data, and 2,748 patients had data at both times. HRQOL was measured using the EQ-5D-3L (Euro-Qol) instrument. Data were collected pre-implant and 3 and 6 months post-operatively. Statistical analyses included chi-square test, t-test, Pearson correlation coefficients, and multiple regression analysis. 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 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, comorbidities, better preoperative HRQOL, adverse events within 6 months after implant, bridge to transplant moderately likely and unlikely, and New York Heart Association Functional Classification IV at 6 months after LVAD (R2 = 41%). Conclusions Overall HRQOL and dimensions of HRQOL improve in sub-groups 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.
KW - age
KW - gender
KW - health-related quality of life
KW - left ventricular assist device
KW - risk factors
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U2 - 10.1016/j.healun.2016.01.1222
DO - 10.1016/j.healun.2016.01.1222
M3 - Article
C2 - 27068037
AN - SCOPUS:84962749306
SN - 1053-2498
VL - 35
SP - 777
EP - 788
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 6
ER -