Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation

J Heart Lung Transplant. 2014 Apr;33(4):412-21. doi: 10.1016/j.healun.2013.10.017. Epub 2013 Oct 23.

Abstract

Background: The severity of pre-implantation heart failure may affect post-implantation health-related quality of life (HRQOL). The purpose of our study was to examine differences in HRQOL from before mechanical circulatory support (MCS) through 1 year after surgery by Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patient profiles.

Methods: Data from 1,559 adults with advanced heart failure who received primary continuous-flow pumps between June 23, 2006, and March 31, 2010, and were enrolled in INTERMACS were analyzed. HRQOL data were collected using the EQ-5D-3L survey before implantation and at 3, 6, and 12 months after implantation. Statistical analyses included chi-square and t-tests, using all available data for each time period. Paired t-tests and sensitivity analyses were also conducted.

Results: HRQOL was poor before MCS implantation among patients with INTERMACS profiles 1 to 7 and significantly improved after MCS implantation for all profiles. Stratified by INTERMACS profile, problems within each of the 5 dimensions of HRQOL (i.e., mobility, self-care, usual activities, pain, and anxiety/depression) generally decreased from before to after implantation. By 6 months after implantation, patients with all INTERMACS profiles reported similar frequencies of problems for all HRQOL dimensions. Paired t-tests and sensitivity analyses supported almost all of our findings.

Conclusions: HRQOL is poor among advanced heart failure patients with INTERMACS profiles 1 to 7 before MCS implantation and improves to similar levels for patients who remained on MCS 1 year after surgery. Patients have problems in HRQOL dimensions before and after MCS; however, the frequency of reporting problems decreases for all dimensions within most profiles across time.

Keywords: INTERMACS; continuous-flow pump; health-related quality of life; heart failure; mechanical circulatory support.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / psychology*
  • Heart Failure / therapy*
  • Heart-Assist Devices / psychology*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / physiopathology
  • Postoperative Complications / psychology*
  • Quality of Life / psychology*
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / psychology*
  • Shock, Cardiogenic / therapy*
  • Surveys and Questionnaires
  • Survival Analysis