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. 2016 Jun;35(6):777-88.
doi: 10.1016/j.healun.2016.01.1222. Epub 2016 Feb 8.

Age and gender differences and factors related to change in health-related quality of life from before to 6 months after left ventricular assist device implantation: Findings from Interagency Registry for Mechanically Assisted Circulatory Support

Kathleen L Grady  1 , Sherri Wissman  2 , David C Naftel  3 , Susan Myers  3 , Annetine Gelijins  4 , Alan Moskowitz  5 , Francis D Pagani  6 , James B Young  7 , John A Spertus  8 , James K Kirklin  3
Affiliations

Age and gender differences and factors related to change in health-related quality of life from before to 6 months after left ventricular assist device implantation: Findings from Interagency Registry for Mechanically Assisted Circulatory Support

Kathleen L Grady et al. J Heart Lung Transplant. 2016 Jun.

Abstract

Background: Gaps in the literature exist regarding health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) surgery. The purposes of our study were to describe HRQOL over time, by age and gender, and identify risk factors for poor HRQOL early after LVAD implant.

Methods: Patients (n = 7,353) from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database received a continuous-flow LVAD as a primary implant at 133 United States hospitals. Of these, 5,640 patients had pre-LVAD HRQOL data, 3,353 patients had 6-month post-LVAD HRQOL data, and 2,748 patients had data at both times. HRQOL was measured using the EQ-5D-3L (Euro-Qol) instrument. Data were collected pre-implant and 3 and 6 months post-operatively. Statistical analyses included chi-square test, t-test, Pearson correlation coefficients, and multiple regression analysis.

Results: Overall HRQOL and dimensions of HRQOL improved from before to 6 months after device implant when examined by age and gender. However, younger patients and women reported significantly more problems regarding all dimensions before implant and significantly more problems regarding pain/discomfort and anxiety/depression at 3 and 6 months after implant. An increase in overall HRQOL from before to 6 months after implant was related to pre-implant INTERMACS Level 1. Factors related to a decrease in HRQOL from before to 6 months after implant were listed for heart transplant before surgery, comorbidities, better preoperative HRQOL, adverse events within 6 months after implant, bridge to transplant moderately likely and unlikely, and New York Heart Association Functional Classification IV at 6 months after LVAD (R(2) = 41%).

Conclusions: Overall HRQOL and dimensions of HRQOL improve in sub-groups of patients from before to 6 months after surgery, although differences in improvement exist. Adverse events are risk factors for decreased HRQOL across time and support the ongoing need to improve device technology with the aim of reducing adverse events.

Keywords: age; gender; health-related quality of life; left ventricular assist device; risk factors.

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Figures

Figure 1
Figure 1
Theoretical Framework of the Effect of Disease and Treatment on HRQOL, modified
Figure 2
Figure 2
Change in HRQOL Dimensions Across Time by Age
Figure 3
Figure 3
Change in Mobility Across Time by Age
Figure 4
Figure 4
Change in Self Care Across Time by Age
Figure 5
Figure 5
Change in Usual Activities Across Time by Age
Figure 6
Figure 6
Change in Pain/Discomfort Across Time by Age
Figure 7
Figure 7
Change in Anxiety/Depression Across Time by Age
Figure 8
Figure 8
Change in Mobility Across Time by Gender
Figure 9
Figure 9
Change in Self Care Across Time by Gender
Figure 10
Figure 10
Change in Usual Activities Across Time by Gender
Figure 11
Figure 11
Change in Pain/Discomfort Across Time by Gender
Figure 12
Figure 12
Change in Anxiety/Depression Across Time by Gender
Figure 13
Figure 13
Predictions of post implant VAS score by pre implant INTERMACS profile 1
Figure 14
Figure 14
Predictions of post implant VAS score by pre implant INTERMACS profile 2
Figure 15
Figure 15
Predictions of post implant VAS score by pre implant INTERMACS profile 3
Figure 16
Figure 16
Predictions of post implant VAS score by pre implant INTERMACS profiles 4–7
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