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Multicenter Study
. 2015 Feb;34(2):213-21.
doi: 10.1016/j.healun.2014.10.001. Epub 2014 Oct 31.

Change in health-related quality of life from before to after destination therapy mechanical circulatory support is similar for older and younger patients: analyses from INTERMACS

Kathleen L Grady  1 , David C Naftel  2 , Susan Myers  2 , Mary Amanda Dew  3 , Gerdi Weidner  4 , John A Spertus  5 , Katharine Idrissi  6 , Hochang B Lee  7 , Edwin C McGee  8 , James K Kirklin  2
Affiliations
Multicenter Study

Change in health-related quality of life from before to after destination therapy mechanical circulatory support is similar for older and younger patients: analyses from INTERMACS

Kathleen L Grady et al. J Heart Lung Transplant. 2015 Feb.

Abstract

Background: Destination therapy left ventricular assist devices (DT LVADs) are being implanted in older adults on an increasing basis. Older patients have a higher risk for mortality and morbidity post-LVAD, which may impact their health-related quality of life (HRQOL). We aimed to determine the change in HRQOL by age from before implant to 1 year after DT LVAD implant and identify factors associated with the change.

Methods: Data were collected from 1,470 continuous-flow DT LVAD patients at 108 institutions participating in INTERMACS from January 21, 2010 to March 31, 2012. Patients were divided into three cohorts: <60 years of age (n = 457); 60 to 69 years of age (n = 520); and ≥70 years of age (n = 493). HRQOL was measured using the generic EuroQol instrument (EQ-5D-3L). Data were collected pre-implant and 3, 6 and 12 months post-implant. Statistical analyses included descriptive statistics, Kaplan-Meier survival analyses and multivariable regression analyses.

Results: HRQOL improved in all patients. Generally, older patients reported better HRQOL than younger patients pre-implant (≥70 years: mean 40; 60 to 69 years: mean 33; and <60 years: mean 31; p < 0.0001) and 1 year post-implant (≥70 years: mean 77; 60 to 69 years: mean 72; <60 years: mean 70; p = 0.01) using the EQ-5D visual analog scale (VAS), with 0 = worst imaginable health state and 100 = best imaginable health state. The magnitude of improvement in EQ-5D scores from pre-implant to 1-year post-LVAD implant was similar in all age groups (≥70 years: mean change 33; 60 to 69 years: mean change 35; <60 years: mean change 35; p = 0.77). Factors associated with improvement in HRQOL from before to 1 year after implant were a lower VAS score pre-implant and fewer rehospitalizations post-implant (R(2) = 61.3%, p < 0.0001).

Conclusions: Older patients reported better HRQOL than younger patients before and after LVAD implantation. The magnitude of improvement was similar for all age groups, with >70% of all patients showing clinically significant increases (>10 points on the VAS). Rehospitalization appears to reduce the magnitude of improvement.

Keywords: age; destination therapy; left ventricular assist devices; mechanical circulatory support; quality of life; ventricular assist devices.

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Figures

Figure 1
Figure 1
Survival Analyses by Age Group
Figure 2
Figure 2
EQ-5D Physical Function / Activities of Daily Living Dimensions by Age Group
Figure 3
Figure 3
EQ-5E Pain / Emotions Dimensions by Age Group
Figure 4
Figure 4
Factors Associated with Change in HRQOL (VAS score), n=435
See this image and copyright information in PMC

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