Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis

Arman Kilic, Jennie H. Kwon, Kathleen L. Grady, Brandon A. Singletary, Ahmet Kilic, Melanie Everitt, Joseph Cleveland, Ryan S. Cantor, Shanda Blackmon, Khadijah Breathett, Stephen McKellar, Mary Keebler, James K. Kirklin, Josef Stehlik

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. Methods: Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. Results: Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. Conclusions: AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.

Original languageEnglish (US)
Pages (from-to)1214-1222
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume42
Issue number9
DOIs
StatePublished - Sep 2023

Keywords

  • left ventricular assist device
  • outcomes
  • quality metrics
  • quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Transplantation
  • Pulmonary and Respiratory Medicine
  • Surgery

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