Infections following left ventricular assist device implantation and 1-year health-related quality of life

Shiwei Zhou*, Guangyu Yang, Hechuan Hou, Min Zhang, Kathleen L. Grady, Carol E. Chenoweth, Keith D. Aaronson, Michael Pienta, Michael D. Fetters, P. Paul Chandanabhumma, James W. Stewart, Lourdes Cabrera, Preeti N. Malani, Francis D. Pagani, Donald S. Likosky

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Left ventricular assist device (LVAD) implantation leads to substantial and sustained improvement in health-related quality of life (HRQOL) among patients. Infection following device implantation remains an important and frequent complication and adversely affects patient-reported HRQOL. Methods: Patients in The Society of Thoracic Surgeons’ Interagency Registry for Mechanically Assisted Circulatory Support receiving a primary LVAD between April 2012 to October 2016 were included. The primary exposure was one-year post-implant infection, characterized by: (1) any infection; (2) total number of infections and (3) type (LVAD-specific, LVAD-related, non-LVAD). The association between infection and the primary composite adverse outcome (defined as EuroQoL Visual Analog Scale< 65, too sick to complete the survey, or death at 1-year) was estimated using inverse probability weighting and Cox regression. Results: The study cohort included 11,618 patients from 161 medical centers with 4,768 (41.0%) patients developing an infection, and 2,282 (19.6%) patients having> 1 infection during the follow up period. The adjusted odds ratio for the primary composite adverse outcome was 1.22 (95% CI, 1.19–1.24, p < 0.001) for each additional infection. Each additional infection was associated with a 3.49% greater probability of the primary composite outcome and was associated with worse performance across multiple dimensions of HRQOL as assessed by the EQ-5D for patients who survived to 1 year. Conclusions: For patients undergoing LVAD implantation, each additional infection within the first post-implantation year was associated with an incremental negative effect on survival free of impaired HRQOL.

Original languageEnglish (US)
Pages (from-to)1307-1315
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume42
Issue number9
DOIs
StatePublished - Sep 2023

Keywords

  • health-related quality of life
  • infection
  • mechanical circulatory support
  • ventricular assist device

ASJC Scopus subject areas

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

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