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Comparative Study
. 2024 Sep;43(9):1422-1433.
doi: 10.1016/j.healun.2024.05.008. Epub 2024 May 17.

A comparison of quality-adjusted life years in older adults after heart transplantation versus long-term mechanical support: Findings from the SUSTAIN-IT study

Kathleen L Grady  1 , Mary Amanda Dew  2 , Francis D Pagani  3 , John A Spertus  4 , Eileen Hsich  5 , Melana Yuzefpolskaya  6 , Brent Lampert  7 , James K Kirklin  8 , Michael Petty  9 , Andrew Kao  10 , Clyde Yancy  11 , Justin Hartupee  12 , Salpy V Pamboukian  13 , Maryl Johnson  14 , Margaret Murray  14 , Tingqing Wu  11 , Adin-Cristian Andrei  15
Affiliations
Comparative Study

A comparison of quality-adjusted life years in older adults after heart transplantation versus long-term mechanical support: Findings from the SUSTAIN-IT study

Kathleen L Grady et al. J Heart Lung Transplant. 2024 Sep.

Abstract

Background: The quality-adjusted life year (QALY) measures disease burden and treatment, combining overall survival and health-related quality of life (HRQOL). We estimated QALYs in 3 groups of older patients (60-80 years) with heart failure (HF) who underwent heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or HT without pre-transplant MCS [HT Non-MCS]) or long-term MCS (destination therapy). We also identified factors associated with gains in QALYs through 24 months follow-up.

Methods: Of 393 eligible patients enrolled (10/1/15-12/31/18) at 13 U.S. sites, 161 underwent HT (n = 68 HT MCS, n = 93 HT Non-MCS) and 144 underwent long-term MCS. Survival and HRQOL data were collected through 24 months. QALY health utilities were based on patient self-report of EQ-5D-3L dimensions. Mean-restricted QALYs were compared among groups using generalized linear models.

Results: For the entire cohort, mean age in years closest to surgery was 67 (standard deviation, SD: 4.7), 78% were male, and 83% were White. By 18 months post-surgery, sustained significant differences in adjusted average ± SD QALYs emerged across groups, with the HT Non-MCS group having the highest average QALYs (24-month window: HT Non-MCS = 22.58 ± 1.1, HT MCS = 19.53 ± 1.33, Long-term MCS = 19.49 ± 1.3, p = 0.003). At 24 months post-operatively, a lower gain in QALYs was associated with HT MCS, long-term MCS, a lower pre-operative LVEF, NYHA class III or IV before surgery, and an ischemic or other etiology of HF.

Conclusions: Determination of QALYs may provide important information for policy makers and clinicians to consider regarding benefits of HT and long-term MCS as treatment options for older patients with HF.

Keywords: heart transplantation; mechanical circulatory support; quality of life; quality-adjusted life years; survival.

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Conflict of interest statement

Kathleen L. Grady, NIH/NIA and NIH/NHLBI grants; payment of registration fees for scientific meetings (AHA, HFSA, ACC, ISHLT); leadership role (member ISHLT Board of Directors, Foundation Board, Research Oversight Committee, Governance Committee, Leadership Advisory Forum, and chair Grants and Awards Committee).

Mary Amanda Dew, NIH grants.

Francis D. Pagani, none.

John A. Spertus, NIH grants; research contracts from Janssen and Abbott Vascular and BMS; royalties or licenses for SAQ, KCCQ-12, and PAQ; consulting fees from Alnylam, BMS, Sanofi, Edwards, Bayer, Terumo, Cytokinetics, Imbria, Janssen, Merck, Pfizer, Lilly, United Healthcare; participation on the NIH funded RECOVER DSMB; Board member of Blue Cross Blue Shield of Kansas City.

Eileen Hsich, NIH/NHLBI grant.

Melana Yuzefpolskaya, Abbott Educational grant; Abbott Speakers Bureau.

Brent Lampert, DO, none.

James K. Kirklin, MD, Intellectual properties for IT software development in registry database design developed at and licensed from the University of Alabama at Birmingham; Chair of DSMB for Xeltis cardiac conduit clinical trial, Chair of DSMB for Carmat TAH clinical trial, and Chair- XVIVO Clinical Safety Monitoring Board - Tx preservation technology; President; World Society for Pediatric and Congenital Heart Surgery; Common stock in Kirklin Solutions Co. Database development and analytics; receive partial salary support in my role as Director of the Data Center for STS Intemacs/Pedimacs Registries.

Michael Petty, payment for lectures for Abbott Labs.

Andrew Kao, MD, honoraria from Kansas Association of Sleep Professionals and the American Board of Internal Medicine; support for attending meetings for CareDX, American Board of Internal Medicine, and United Network for Organ Sharing; participation on the CareDX DSMB or Advisory Board. Clyde Yancy, participation on a DSMB or Advisory Board for the NHLBI Cardiothoracic Surgery Clinical Trials Network.

Justin Hartupee, honoraria for lectures from Bristol Myers Squibb; payment for expert testimony; support for attending meetings by Abbott.

Salpy V. Pamboukian, MD, participation on the Clinical Events Committee, Chair Carmat Total Artificial Heart.

Maryl Johnson, MD, none.

Margaret Murray, none.

Tingqing Wu, none.

Adin-Cristian Andrei, NH/NIA grant.

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