Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy

Michael S. Kiernan*, Kartik S. Sundareswaran, Duc Thinh Pham, Navin K. Kapur, Naveen L. Pereira, Martin Strueber, David J. Farrar, David DeNofrio, Joseph G. Rogers

*Corresponding author for this work

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Left ventricular assist devices (LVADs) improve survival, quality of life (QOL), and functional capacity (FC) among patients with end-stage heart failure. Few data are available regarding characteristics associated with QOL and FC response. Methods and Results Patients enrolled in the Heartmate II clinical trials that were alive with ongoing LVAD support at 6 months were included. QOL response criteria included scoring above the lowest quartile on either the Minnesota Living With Heart Failure Questionnaire or the Kansas City Cardiomyopathy Questionnaire. FC responder criteria included improvement in 6-minute walk distance (6MWD) >70 meters from baseline, a 6MWD >220 meters at 6 months, or New York Heart Association functional class I or II. Independent variables associated with QOL nonresponse included history of diabetes (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.20–2.78), lower mean pulmonary arterial pressure (OR 0.97, 95% CI 0.95–0.99), or a Heartmate II right ventricular risk score >2 (OR 1.77, 95% CI 1.00–3.12). Variables associated with FC nonresponse included history of COPD (OR 1.92, 95% CI 1.22–3.03) or diabetes (OR 1.52, 95% CI 1.01–2.27). Compared with responders, QOL and FC nonresponders had reduced long-term survival. Conclusions Preoperative comorbidities, including diabetes, COPD, and right heart failure, may limit the QOL and FC response to LVAD therapy and should be considered during the shared decision-making process.

Original languageEnglish (US)
Pages (from-to)797-805
Number of pages9
JournalJournal of Cardiac Failure
Volume22
Issue number10
DOIs
StatePublished - Oct 1 2016

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Heart-Assist Devices
Quality of Life
Odds Ratio
Confidence Intervals
Heart Failure
Chronic Obstructive Pulmonary Disease
Therapeutics
Survival
Cardiomyopathies
Comorbidity
Decision Making
Arterial Pressure
Clinical Trials
Lung

Keywords

  • Left ventricular assist device
  • exercise tolerance
  • functional capacity
  • heart failure
  • predictors
  • quality of life
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kiernan, Michael S. ; Sundareswaran, Kartik S. ; Pham, Duc Thinh ; Kapur, Navin K. ; Pereira, Naveen L. ; Strueber, Martin ; Farrar, David J. ; DeNofrio, David ; Rogers, Joseph G. / Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy. In: Journal of Cardiac Failure. 2016 ; Vol. 22, No. 10. pp. 797-805.
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title = "Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy",
abstract = "Background Left ventricular assist devices (LVADs) improve survival, quality of life (QOL), and functional capacity (FC) among patients with end-stage heart failure. Few data are available regarding characteristics associated with QOL and FC response. Methods and Results Patients enrolled in the Heartmate II clinical trials that were alive with ongoing LVAD support at 6 months were included. QOL response criteria included scoring above the lowest quartile on either the Minnesota Living With Heart Failure Questionnaire or the Kansas City Cardiomyopathy Questionnaire. FC responder criteria included improvement in 6-minute walk distance (6MWD) >70 meters from baseline, a 6MWD >220 meters at 6 months, or New York Heart Association functional class I or II. Independent variables associated with QOL nonresponse included history of diabetes (odds ratio [OR] 1.82, 95{\%} confidence interval [CI] 1.20–2.78), lower mean pulmonary arterial pressure (OR 0.97, 95{\%} CI 0.95–0.99), or a Heartmate II right ventricular risk score >2 (OR 1.77, 95{\%} CI 1.00–3.12). Variables associated with FC nonresponse included history of COPD (OR 1.92, 95{\%} CI 1.22–3.03) or diabetes (OR 1.52, 95{\%} CI 1.01–2.27). Compared with responders, QOL and FC nonresponders had reduced long-term survival. Conclusions Preoperative comorbidities, including diabetes, COPD, and right heart failure, may limit the QOL and FC response to LVAD therapy and should be considered during the shared decision-making process.",
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author = "Kiernan, {Michael S.} and Sundareswaran, {Kartik S.} and Pham, {Duc Thinh} and Kapur, {Navin K.} and Pereira, {Naveen L.} and Martin Strueber and Farrar, {David J.} and David DeNofrio and Rogers, {Joseph G.}",
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Kiernan, MS, Sundareswaran, KS, Pham, DT, Kapur, NK, Pereira, NL, Strueber, M, Farrar, DJ, DeNofrio, D & Rogers, JG 2016, 'Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy', Journal of Cardiac Failure, vol. 22, no. 10, pp. 797-805. https://doi.org/10.1016/j.cardfail.2016.01.006

Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy. / Kiernan, Michael S.; Sundareswaran, Kartik S.; Pham, Duc Thinh; Kapur, Navin K.; Pereira, Naveen L.; Strueber, Martin; Farrar, David J.; DeNofrio, David; Rogers, Joseph G.

In: Journal of Cardiac Failure, Vol. 22, No. 10, 01.10.2016, p. 797-805.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy

AU - Kiernan, Michael S.

AU - Sundareswaran, Kartik S.

AU - Pham, Duc Thinh

AU - Kapur, Navin K.

AU - Pereira, Naveen L.

AU - Strueber, Martin

AU - Farrar, David J.

AU - DeNofrio, David

AU - Rogers, Joseph G.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background Left ventricular assist devices (LVADs) improve survival, quality of life (QOL), and functional capacity (FC) among patients with end-stage heart failure. Few data are available regarding characteristics associated with QOL and FC response. Methods and Results Patients enrolled in the Heartmate II clinical trials that were alive with ongoing LVAD support at 6 months were included. QOL response criteria included scoring above the lowest quartile on either the Minnesota Living With Heart Failure Questionnaire or the Kansas City Cardiomyopathy Questionnaire. FC responder criteria included improvement in 6-minute walk distance (6MWD) >70 meters from baseline, a 6MWD >220 meters at 6 months, or New York Heart Association functional class I or II. Independent variables associated with QOL nonresponse included history of diabetes (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.20–2.78), lower mean pulmonary arterial pressure (OR 0.97, 95% CI 0.95–0.99), or a Heartmate II right ventricular risk score >2 (OR 1.77, 95% CI 1.00–3.12). Variables associated with FC nonresponse included history of COPD (OR 1.92, 95% CI 1.22–3.03) or diabetes (OR 1.52, 95% CI 1.01–2.27). Compared with responders, QOL and FC nonresponders had reduced long-term survival. Conclusions Preoperative comorbidities, including diabetes, COPD, and right heart failure, may limit the QOL and FC response to LVAD therapy and should be considered during the shared decision-making process.

AB - Background Left ventricular assist devices (LVADs) improve survival, quality of life (QOL), and functional capacity (FC) among patients with end-stage heart failure. Few data are available regarding characteristics associated with QOL and FC response. Methods and Results Patients enrolled in the Heartmate II clinical trials that were alive with ongoing LVAD support at 6 months were included. QOL response criteria included scoring above the lowest quartile on either the Minnesota Living With Heart Failure Questionnaire or the Kansas City Cardiomyopathy Questionnaire. FC responder criteria included improvement in 6-minute walk distance (6MWD) >70 meters from baseline, a 6MWD >220 meters at 6 months, or New York Heart Association functional class I or II. Independent variables associated with QOL nonresponse included history of diabetes (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.20–2.78), lower mean pulmonary arterial pressure (OR 0.97, 95% CI 0.95–0.99), or a Heartmate II right ventricular risk score >2 (OR 1.77, 95% CI 1.00–3.12). Variables associated with FC nonresponse included history of COPD (OR 1.92, 95% CI 1.22–3.03) or diabetes (OR 1.52, 95% CI 1.01–2.27). Compared with responders, QOL and FC nonresponders had reduced long-term survival. Conclusions Preoperative comorbidities, including diabetes, COPD, and right heart failure, may limit the QOL and FC response to LVAD therapy and should be considered during the shared decision-making process.

KW - Left ventricular assist device

KW - exercise tolerance

KW - functional capacity

KW - heart failure

KW - predictors

KW - quality of life

KW - survival

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