Both Patient and Caregiver Factors are Related to Patient Health-Related Quality of Life before Surgery

K. L. Grady, Y. Xu, Adin-Cristian Andrei, A. Warzecha, A. Kao, E. M. Hsich, M. Dew, R. L. Kormos, D. Pham, S. LaRue, M. G. Petty, W. G. Cotts, S. V. Pamboukian, F. D. Pagani, B. C. Lampert, M. R. Johnson, M. A. Murray, K. Tekeda, M. Yuzefpolskaya, S. SilvestryJ. Spertus, J. K. Kirklin, S. Collum, Clyde W Yancy

Research output: Contribution to journalArticle

Abstract

PURPOSE: Factors related to health-related quality of life (HRQOL) of older patients (pts) with advanced heart failure (HF) scheduled for left ventricular assist device (LVAD) implantation as destination therapy (DT) or while a candidate for heart transplantation (HT) with or without an LVAD, may guide therapeutic strategies. We sought to identify pt and caregiver (cg) factors related to HRQOL of pts (60-80 years) awaiting these surgeries. METHODS: From 10/1/15-12/31/18, we enrolled 302 pts with cgs (n=302) from 13 U.S. sites: 193 pts awaiting HT (92 with and 101 without LVAD) and 109 DT LVAD pts. Pts completed the EQ-5D-3L Visual Analog Scale (VAS): 0-100 (worst-best) health; KCCQ-12 summary score (SS), 0-100=low-high; PHQ-8 (0-24; score >10=significant depressive symptoms) and STAI-state (20-80; higher score=more anxiety). Cgs completed the EQ-5D, STAI, PHQ-8 and Oberst Caregiving Burden Scale (OCBS): 2 subscales (time and difficulty, 1-5; higher score=more time and more task difficulty). Analyses included multivariable logistic regression models; the binary outcomes were whether individual EQ-5D VAS and KCCQ-12 SSs were higher than the cohort median of 60 and 46, respectively. RESULTS: Pts were 66.1±4.5 years, 82% male, and 86% white. Pts reported relatively low generic HRQOL (VAS mean=55.3±23.5) and low HF-specific HRQOL (SS mean=47.5±22.5), both with significant group differences. HT pts with LVADs were more likely to have higher EQ-5D VAS scores; DT pts had the lowest VAS scores (p< 0.001). PHQ-8 >10 was related to lower VAS scores (p< 0.001). HT pts with LVADs were more likely to have a higher KCCQ-12 SS, DT pts had the lowest score (p< 0.001), and PHQ-8>10 was related to lower KCCQ-12 SSs (p< 0.001). Pts whose cgs spent the most time caregiving (top quartile) had lower KCCQ-12 SSs (OR = 0.45, p=0.002) (table). CONCLUSION: Implant strategy, pt depression, and cg time spent on care were significantly related to older advanced HF pt HRQOL. Findings may inform interventions for HF pts awaiting surgery.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Grady, K. L., Xu, Y., Andrei, A-C., Warzecha, A., Kao, A., Hsich, E. M., Dew, M., Kormos, R. L., Pham, D., LaRue, S., Petty, M. G., Cotts, W. G., Pamboukian, S. V., Pagani, F. D., Lampert, B. C., Johnson, M. R., Murray, M. A., Tekeda, K., Yuzefpolskaya, M., ... Yancy, C. W. (2020). Both Patient and Caregiver Factors are Related to Patient Health-Related Quality of Life before Surgery. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 39(4), S92-S93. https://doi.org/10.1016/j.healun.2020.01.933