Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric

Michigan Congestive Heart Failure Investigators

doi:10.1016/j.healun.2022.07.001

Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric

Michigan Congestive Heart Failure Investigators

Surgery, Cardiac Surgery Division

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

2 Scopus citations

Abstract

Background: Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons’ Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. Methods: Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire “KCCQ”) incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. Results: The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). Conclusions: Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.

Original language	English (US)
Pages (from-to)	1520-1528
Number of pages	9
Journal	Journal of Heart and Lung Transplantation
Volume	41
Issue number	10
DOIs	https://doi.org/10.1016/j.healun.2022.07.001
State	Published - Oct 2022

Funding

This study was supported by a grant from the Agency for Healthcare Research and Quality (R01HS026003). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Support for the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program. The opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM, The Society of Thoracic Surgeons, National Heart, Lung, and Blood Institute, or any of its employees. Donald S. Likosky receives research funding from the Agency for Healthcare Research and Quality ( R01HS026003 ) and the National Institutes of Health ( R01HL146619 ) and serves as a consultant for the American Society of Extracorporeal Technology. Donald S. Likosky receives partial salary support from Blue Cross Blue Shield of Michigan to advance quality in Michigan in conjunction with the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Francis D. Pagani is an ad hoc, non-compensated scientific advisor for Medtronic, Abbott, FineHeart, and CH Biomedical and a member of the Data Safety Monitoring Board for Carmat and the National Heart, Lung, and Blood Institute PumpKIN Study. Keith D. Aaronson has consulting relationships with Medtronic (honoraria) and Abbott (honoraria). James W. Stewart II is funded through the Veterans Affairs as a National Clinician Scholars Program (NCSP) research fellow at the University of Michigan. Donald S. Likosky receives research funding from the Agency for Healthcare Research and Quality (R01HS026003) and the National Institutes of Health (R01HL146619) and serves as a consultant for the American Society of Extracorporeal Technology. Donald S. Likosky receives partial salary support from Blue Cross Blue Shield of Michigan to advance quality in Michigan in conjunction with the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Francis D. Pagani is an ad hoc, non-compensated scientific advisor for Medtronic, Abbott, FineHeart, and CH Biomedical and a member of the Data Safety Monitoring Board for Carmat and the National Heart, Lung, and Blood Institute PumpKIN Study. Keith D. Aaronson has consulting relationships with Medtronic (honoraria) and Abbott (honoraria). James W. Stewart II is funded through the Veterans Affairs as a National Clinician Scholars Program (NCSP) research fellow at the University of Michigan.

Keywords

infection
left ventricular assist device
mortality
outcomes
quality metrics
quality of life
renal dysfunction

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Transplantation
Pulmonary and Respiratory Medicine
Surgery

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10.1016/j.healun.2022.07.001

Cite this

@article{0e8f36a02c8c4e0ab835a0cd39c6bd86,

title = "Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric",

abstract = "Background: Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons{\textquoteright} Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. Methods: Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire “KCCQ”) incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. Results: The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). Conclusions: Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.",

keywords = "infection, left ventricular assist device, mortality, outcomes, quality metrics, quality of life, renal dysfunction",

author = "{Michigan Congestive Heart Failure Investigators} and Guangyu Yang and Min Zhang and Shiwei Zhou and Hechuan Hou and Grady, {Kathleen L.} and Stewart, {James W.} and Chenoweth, {Carol E.} and Aaronson, {Keith D.} and Fetters, {Michael D.} and Chandanabhumma, {P. Paul} and Pienta, {Michael J.} and Malani, {Preeti N.} and Hider, {Ahmad M.} and Lourdes Cabrera and Pagani, {Francis D.} and Likosky, {Donald S.}",

note = "Publisher Copyright: {\textcopyright} 2022 International Society for Heart and Lung Transplantation",

year = "2022",

month = oct,

doi = "10.1016/j.healun.2022.07.001",

language = "English (US)",

volume = "41",

pages = "1520--1528",

journal = "Journal of Heart and Lung Transplantation",

issn = "1053-2498",

publisher = "Elsevier USA",

number = "10",

}

TY - JOUR

T1 - Incompleteness of health-related quality of life assessments before left ventricular assist device implant

T2 - A novel quality metric

AU - Michigan Congestive Heart Failure Investigators

AU - Yang, Guangyu

AU - Zhang, Min

AU - Zhou, Shiwei

AU - Hou, Hechuan

AU - Grady, Kathleen L.

AU - Stewart, James W.

AU - Chenoweth, Carol E.

AU - Aaronson, Keith D.

AU - Fetters, Michael D.

AU - Chandanabhumma, P. Paul

AU - Pienta, Michael J.

AU - Malani, Preeti N.

AU - Hider, Ahmad M.

AU - Cabrera, Lourdes

AU - Pagani, Francis D.

AU - Likosky, Donald S.

PY - 2022/10

Y1 - 2022/10

N2 - Background: Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons’ Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. Methods: Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire “KCCQ”) incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. Results: The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). Conclusions: Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.

AB - Background: Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons’ Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. Methods: Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire “KCCQ”) incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. Results: The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). Conclusions: Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.

KW - infection

KW - left ventricular assist device

KW - mortality

KW - outcomes

KW - quality metrics

KW - quality of life

KW - renal dysfunction

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Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric

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