Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis

Arman Kilic; Jennie H. Kwon; Kathleen L. Grady; Brandon A. Singletary; Ahmet Kilic; Melanie Everitt; Joseph Cleveland; Ryan S. Cantor; Shanda Blackmon; Khadijah Breathett; Stephen McKellar; Mary Keebler; James K. Kirklin; Josef Stehlik

doi:10.1016/j.healun.2023.04.001

Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis

Arman Kilic^*, Jennie H. Kwon, Kathleen L. Grady, Brandon A. Singletary, Ahmet Kilic, Melanie Everitt, Joseph Cleveland, Ryan S. Cantor, Shanda Blackmon, Khadijah Breathett, Stephen McKellar, Mary Keebler, James K. Kirklin, Josef Stehlik

^*Corresponding author for this work

Surgery, Cardiac Surgery Division

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. Methods: Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. Results: Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. Conclusions: AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.

Original language	English (US)
Pages (from-to)	1214-1222
Number of pages	9
Journal	Journal of Heart and Lung Transplantation
Volume	42
Issue number	9
DOIs	https://doi.org/10.1016/j.healun.2023.04.001
State	Published - Sep 2023

Funding

AK serves as speaker and consultant for Abiomed, 3ive, LivaNova, and Abbott. JK receives research support from the National Institute of Health ( T32HL007260 ). KLG serves as a consultant for Amgen, Inc. and receives research support from the National Institute of Health ( R01HL130502, R01AG047416 ) and the American Heart Association . She serves on the Board of Directors and as Chair for the Grants and Awards Committee for the International Society for Heart and Lung transplantation and is supported for travel to the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support Advances in Quality & Outcomes Conference. KB receives research support from the National Institute of Health ( K01HL142848, R01HL159216, R56HL159216, L30HL148881 ) and serves on committees for the American Heart Association, Heart Failure Society of America, and Association of Black Cardiologists. JKK serves as Director for the Data Center STS/INTERMACS database (Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support) and receives partial salary support through funds paid to his institution. JS serves as consultant for Medtronic, Natera, and TransMedics, receives research funding from Merck and Natera, and owns stock or stock options in TransMedics. The other authors report no conflicts. AK serves as speaker and consultant for Abiomed, 3ive, LivaNova, and Abbott. JK receives research support from the National Institute of Health (T32HL007260). KLG serves as a consultant for Amgen, Inc. and receives research support from the National Institute of Health (R01HL130502, R01AG047416) and the American Heart Association. She serves on the Board of Directors and as Chair for the Grants and Awards Committee for the International Society for Heart and Lung transplantation and is supported for travel to the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support Advances in Quality & Outcomes Conference. KB receives research support from the National Institute of Health (K01HL142848, R01HL159216, R56HL159216, L30HL148881) and serves on committees for the American Heart Association, Heart Failure Society of America, and Association of Black Cardiologists. JKK serves as Director for the Data Center STS/INTERMACS database (Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support) and receives partial salary support through funds paid to his institution. JS serves as consultant for Medtronic, Natera, and TransMedics, receives research funding from Merck and Natera, and owns stock or stock options in TransMedics. The other authors report no conflicts.

Keywords

left ventricular assist device
outcomes
quality metrics
quality of life

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Transplantation
Pulmonary and Respiratory Medicine
Surgery

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10.1016/j.healun.2023.04.001

Cite this

Kilic, A., Kwon, J. H., Grady, K. L., Singletary, B. A., Kilic, A., Everitt, M., Cleveland, J., Cantor, R. S., Blackmon, S., Breathett, K., McKellar, S., Keebler, M., Kirklin, J. K., & Stehlik, J. (2023). Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis. Journal of Heart and Lung Transplantation, 42(9), 1214-1222. https://doi.org/10.1016/j.healun.2023.04.001

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title = "Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis",

abstract = "Background: We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. Methods: Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. Results: Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. Conclusions: AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.",

keywords = "left ventricular assist device, outcomes, quality metrics, quality of life",

author = "Arman Kilic and Kwon, {Jennie H.} and Grady, {Kathleen L.} and Singletary, {Brandon A.} and Ahmet Kilic and Melanie Everitt and Joseph Cleveland and Cantor, {Ryan S.} and Shanda Blackmon and Khadijah Breathett and Stephen McKellar and Mary Keebler and Kirklin, {James K.} and Josef Stehlik",

note = "Publisher Copyright: {\textcopyright} 2023 International Society for Heart and Lung Transplantation",

year = "2023",

month = sep,

doi = "10.1016/j.healun.2023.04.001",

language = "English (US)",

volume = "42",

pages = "1214--1222",

journal = "Journal of Heart and Lung Transplantation",

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Kilic, A, Kwon, JH, Grady, KL, Singletary, BA, Kilic, A, Everitt, M, Cleveland, J, Cantor, RS, Blackmon, S, Breathett, K, McKellar, S, Keebler, M, Kirklin, JK & Stehlik, J 2023, 'Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis', Journal of Heart and Lung Transplantation, vol. 42, no. 9, pp. 1214-1222. https://doi.org/10.1016/j.healun.2023.04.001

TY - JOUR

T1 - Impact of adverse events on health-related quality of life after left ventricular assist device implantation

T2 - An STS INTERMACS analysis

AU - Kilic, Arman

AU - Kwon, Jennie H.

AU - Grady, Kathleen L.

AU - Singletary, Brandon A.

AU - Kilic, Ahmet

AU - Everitt, Melanie

AU - Cleveland, Joseph

AU - Cantor, Ryan S.

AU - Blackmon, Shanda

AU - Breathett, Khadijah

AU - McKellar, Stephen

AU - Keebler, Mary

AU - Kirklin, James K.

AU - Stehlik, Josef

PY - 2023/9

Y1 - 2023/9

N2 - Background: We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. Methods: Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. Results: Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. Conclusions: AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.

AB - Background: We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. Methods: Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. Results: Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. Conclusions: AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.

KW - left ventricular assist device

KW - outcomes

KW - quality metrics

KW - quality of life

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U2 - 10.1016/j.healun.2023.04.001

DO - 10.1016/j.healun.2023.04.001

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AN - SCOPUS:85160096509

SN - 1053-2498

VL - 42

SP - 1214

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JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

IS - 9

ER -

Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis

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