Change in health-related quality of life from before to after destination therapy mechanical circulatory support is similar for older and younger patients: Analyses from INTERMACS

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Grady, Kathleen L.¹  Naftel, David C.²  Myers, Susan²  Dew, Mary Amanda³  Weidner, Gerdi⁴  Spertus, John A.^5,6  Idrissi, Katharine⁷  Lee, Hochang B.⁸  McGee, Edwin C.⁹  Kirklin, James K.² 

[1] Northwestern Univ, Dept Surg, Div Cardiac Surg, Chicago, IL 60611 USA

[2] Univ Alabama Birmingham, Dept Surg, Birmingham, AL 35294 USA

[3] Univ Pittsburgh, Dept Psychiat, Pittsburgh, PA USA

[4] San Francisco State Univ, Dept Biol, San Francisco, CA 94132 USA

[5] Univ Missouri, St Lukes Mid Amer Heart Inst, Div Cardiovasc Res, Kansas City, MO 64110 USA

[6] Univ Missouri, Dept Biomed & Hlth Informat, Kansas City, MO 64110 USA

[7] Columbia Univ, Dept Surg, New York, NY USA

[8] Yale Univ, Dept Psychiat, New Haven, CT USA

[9] Loyola Univ, Med Ctr, Dept Cardiovasc & Thorac Surg, Maywood, IL 60153 USA

关键词: quality of life;    ventricular assist devices;    left ventricular assist devices;    mechanical circulatory support;    destination therapy;    age;   

DOI  :  10.1016/j.healun.2014.10.001

来源: Elsevier

【 摘 要 】

BACKGROUND: Destination therapy left ventricular assist devices (DT LVADs) are being implanted in older adults on an increasing basis. Older patients have a higher risk for mortality and morbidity post-LVAD, which may impact their health-related quality of life (HRQOL). We aimed to determine the change in BRQOL by age from before implant to 1 year after DT LVAD implant and identify factors associated with the change. METHODS: Data were collected from 1,470 continuous-flow DT LVAD patients at 108 institutions participating in INTERMACS from January 21, 2010 to March 31, 2012. Patients were divided into three cohorts: <60 years of age (n = 457); 60 to 69 years of age (n = 520); and 70 years of age (n = 493). HRQOL was measured using the generic EuroQol instrument (EQ-5D-3L). Data were collected pre-implant and 3,6 and 12 months post-implant. Statistical analyses included descriptive statistics, Kaplan-Meier survival analyses and multivariable regression analyses. RESULTS: HRQOL improved in all patients. Generally, older patients reported better HRQOL than younger patients pre-implant (>= 70 years: mean 40; 60 to 69 years: mean 33; and <60 years: mean 31; p < 0.0001) and 1 year post-implant (>= 70 years: mean 77; 60 to 69 years: mean 72; <60 years: mean 70; p = 0.01) using the EQ-5D visual analog scale (VAS), with 0 = worst imaginable health state and 100 = best imaginable health state. The magnitude of improvement in EQ-5D scores from pre-implant to 1-year post-LVAD implant was similar in all age groups (>= 70 years: mean change 33; 60 to 69 years: mean change 35; <60 years: mean change 35; p = 0.77). Factors associated with improvement in HRQOL from before to 1 year after implant were a lower VAS score pre-implant and fewer rehospitalizations post-implant (R-2 = 61.3%, p < 0.0001). CONCLUSIONS: Older patients reported better BRQOL than younger patients before and after LVAD implantation. The magnitude of improvement was similar for all age groups, with >70% of all patients showing clinically significant increases (> 10 points on the VAS). Rehospitalization appears to reduce the magnitude of improvement. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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