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Observational Study
. 2017 Nov;36(11):1243-1249.
doi: 10.1016/j.healun.2017.05.023. Epub 2017 May 20.

Changes in disease-specific versus generic health status measures after left ventricular assist device implantation: Insights from INTERMACS

Michael E Nassif  1 , John A Spertus  1 , Philip G Jones  1 , Timothy J Fendler  1 , Larry A Allen  2 , Kathleen L Grady  3 , Suzanne V Arnold  4
Affiliations
Observational Study

Changes in disease-specific versus generic health status measures after left ventricular assist device implantation: Insights from INTERMACS

Michael E Nassif et al. J Heart Lung Transplant. 2017 Nov.

Abstract

Background: Quantifying quality of life (QoL) after left ventricular assist device (LVAD) remains challenging. Heart failure (HF)-specific health status measures are ideal for assessing symptoms of HF; however, if patients' QoL is limited by other factors, they may experience improved HF-specific QoL but no concurrent improvement in generic QoL. We sought to examine and predict discrepancies between disease-specific and generic QoL measures after LVAD.

Methods: We examined HF-specific and generic QoL with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol-5D Visual Analog Scale (VAS), respectively, among 1,888 patients with advanced heart failure who underwent LVAD implantation from 2012 to 2014 as part of the INTERMACS registry.

Results: Both measures showed substantial improvement, on average, at 6 months after LVAD, with mean changes of 32.7 ± 25.0 and 27.6 ± 27.4, respectively. Among the 1,539 patients (81.5%) with moderate/large improvement in KCCQ, 334 (21.7%) had discordant changes in generic QoL (i.e., VAS did not substantially increase despite improvement in KCCQ). In a multivariable logistic regression model, baseline VAS score was the strongest predictor of KCCQ-VAS discordance, whereas post-LVAD complications were not significant predictors of discordance.

Conclusions: Most patients have major improvements in both HF-specific and generic QoL after LVAD implantation, and discordance in these measures after LVAD is uncommon. When it did occur, discordance was primarily observed in patients who reported good generic QoL on the VAS before LVAD (despite substantial impairment due to congestive HF). These results support the continued use of HF-specific health status measures to monitor QoL before and after LVAD implantation.

Keywords: health status; heart failure; outcomes; quality of life; ventricular assist devices.

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Conflict of interest statement

Conflict of Interest Disclosures: JAS: owns the copyright to the Kansas City Cardiomyopathy Questionnaire and has served as a consultant to Novartis and Janssen Pharmaceuticals. LAA has served as a consultant for Novartis, Janssen, ZS Pharma, and St. Jude, and receives grant support from the NIH, PCORI, and AHA.

The other authors report no relevant conflicts.

Figures

Figure 1
Figure 1. Flow chart of the analytic cohort
Figure 2
Figure 2. Correlation of changes in KCCQ12-os with EQ-5D VAS from baseline to 6-months after LVAD
Black dots=concordant changes; red dots=discordant changes
Figure 3
Figure 3. Distribution of changes in EQ-5D VAS among patients with improvement in KCCQ12-os
See this image and copyright information in PMC

References

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