Does race influence health-related quality of life outcomes in older patients who undergo advanced cardiac surgical therapies?

Abstract

Background: Racial minorities are disproportionately affected by heart failure (HF). We aimed to determine whether (1) older patients (60-80 years) with HF who underwent long-term mechanical circulatory support (MCS, i.e., destination therapy), compared to patients who underwent heart transplantation (HT), with (HT MCS) or without (HT non-MCS) pretransplant MCS, experienced noninferior change in overall health-related quality of life (HRQOL) by race (White vs racial minorities) from baseline to 1-year postoperatively and (2) race was a risk factor associated with overall HRQOL at 1-year postoperatively.

Methods: Patients were recruited from 13 US medical centers (n = 305). Of the 305 patients who underwent surgery, 107 long-term MCS, 56 HT MCS, and 87 HT non-MCS had data through 1-year follow-up. Analyses included noninferiority (NI) testing using the Kansas City Cardiomyopathy-12 Questionnaire overall summary score (KCCQ-12 OSS, score range = 1[worst]-100[best] HRQOL) at baseline and 3-, 6-, and 12-months follow-up and multivariable linear regression.

Results: The cohort's average age was 66 years, 78% were male, and 84% were White. The long-term MCS racial minority group did not demonstrate NI compared to the HT MCS and HT non-MCS racial minority groups, and the White long-term MCS group did not demonstrate NI compared to the White HT MCS and HT non-MCS groups. Sex (male) and surgical strategies (HT MCS and HT non-MCS) were positively associated with the KCCQ-12 OSS, whereas the number of postoperative adverse events was negatively associated.

Conclusions: Patients experienced improved HRQOL after surgery, regardless of race; demographic and clinical factors were associated with HRQOL.

Keywords: health equity; health-related quality of life; heart transplantation; left ventricular assist device; mechanical circulatory support; race.

Figure 1

Noninferiority findings by Advanced Surgical Therapy Group, overall HRQOL and race over time. : observed means. : Noninferiority margin −5. The null hypothesis tested is H₀: μ_{long-term MCS} − μ_HT < −5, with the alternative H_A: μ_{long-term MCS} − μ_HT ≥ −5. Rejection of H₀ implies the long-term MCS noninferiority.