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. 2014 Apr;33(4):412-21.
doi: 10.1016/j.healun.2013.10.017. Epub 2013 Oct 23.

Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation

Kathleen L Grady  1 , David Naftel  2 , Lynne Stevenson  3 , Mary Amanda Dew  4 , Gerdi Weidner  5 , Francis D Pagani  6 , James K Kirklin  2 , Susan Myers  2 , Timothy Baldwin  7 , James Young  8
Affiliations

Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation

Kathleen L Grady et al. J Heart Lung Transplant. 2014 Apr.

Abstract

Background: The severity of pre-implantation heart failure may affect post-implantation health-related quality of life (HRQOL). The purpose of our study was to examine differences in HRQOL from before mechanical circulatory support (MCS) through 1 year after surgery by Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patient profiles.

Methods: Data from 1,559 adults with advanced heart failure who received primary continuous-flow pumps between June 23, 2006, and March 31, 2010, and were enrolled in INTERMACS were analyzed. HRQOL data were collected using the EQ-5D-3L survey before implantation and at 3, 6, and 12 months after implantation. Statistical analyses included chi-square and t-tests, using all available data for each time period. Paired t-tests and sensitivity analyses were also conducted.

Results: HRQOL was poor before MCS implantation among patients with INTERMACS profiles 1 to 7 and significantly improved after MCS implantation for all profiles. Stratified by INTERMACS profile, problems within each of the 5 dimensions of HRQOL (i.e., mobility, self-care, usual activities, pain, and anxiety/depression) generally decreased from before to after implantation. By 6 months after implantation, patients with all INTERMACS profiles reported similar frequencies of problems for all HRQOL dimensions. Paired t-tests and sensitivity analyses supported almost all of our findings.

Conclusions: HRQOL is poor among advanced heart failure patients with INTERMACS profiles 1 to 7 before MCS implantation and improves to similar levels for patients who remained on MCS 1 year after surgery. Patients have problems in HRQOL dimensions before and after MCS; however, the frequency of reporting problems decreases for all dimensions within most profiles across time.

Keywords: INTERMACS; continuous-flow pump; health-related quality of life; heart failure; mechanical circulatory support.

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Figures

Figure 1
Figure 1
EQ-5D: Visual Analog Scale
Figure 2
Figure 2
Physical Function / Activities of Daily Living Dimensions
Figure 3
Figure 3
Pain / Emotion Dimensions
Figure 4
Figure 4
Comparisons for MCS patients with complete data Includes only patients with a complete EQ-5D prior to implant AND at 1 year post implant, n=348
See this image and copyright information in PMC

References

    1. Braunwald E, Zipes D, Libby P, Bonow R, editors. Braunwald’s Heart Disease: A textbook of cardiovascular medicine. Philadelphia, PA: Elsevier, Inc.; 2005.
    1. Stevenson LW, Pagani FD, Young JB, et al. INTERMACS profiles of advanced heart failure: The current picture. J Heart Lung Transplant. 2009;28:535–541. - PubMed
    1. Kirklin JK, Naftel DC, Kormos R, et al. The Fourth INTERMACS Annual Report: 4,000 implants and counting. J Heart Lung Transplant. 2012;31:117–136. - PubMed
    1. Stepanenko A, Potapov E, Jurmann B, et al. Outcomes of elective versus emergent permanent mechanical circulatory support in the elderly: A single-center experience. J Heart Lung Transplant. 2010;29:61–65. - PubMed
    1. Boyle AJ, Ascheim DD, Russo MJ, et al. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification. J Heart Lung Transplant. 2011;30:402–407. - PubMed

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