Health-Related Quality of Life in Older Patients With Advanced Heart Failure From Before to 2 Years After Heart Transplantation or Long-Term Mechanical Circulatory Support: Findings From the SUSTAIN-IT Study
Kathleen L. Grady, John A. Spertus, Mary Amanda Dew, Tingqing Wu, Scott Silvestry, Maryl Johnson, Eileen Hsich, Brent Lampert, Michael Petty, Salpy V. Pamboukian, Andrew Kao, James K. Kirklin, Duc Thinh Pham, Justin Hartupee, Margaret Murray, Melana Yuzefpolskaya, Koji Takeda, Jerian Dixon-Evans, Adin-Cristian AndreiBACKGROUND:
Health-related quality of life (HRQOL) is a key consideration among older patients with heart failure considering advanced therapies. We evaluated change in HRQOL from before to 24 months after heart transplantation (HT) or long-term mechanical circulatory support (MCS) among older (60–80 years) patients and identified factors associated with HRQOL changes.
METHODS:
Data for this observational study were collected from 13 US sites via patient self-reported measures (EuroQol-5-dimension-3L visual analog scale score: 0=worst–100=best imaginable health state and dimension scores; Kansas City Cardiomyopathy Questionnaire-12 overall summary score/domain scores: 0–100, higher=better health status; other measures) and a 6-minute walk test. Analyses included multivariable linear mixed-effects models.
RESULTS:
Of 393 enrollees, 305 underwent surgery: HT with pretransplant MCS (HT MCS)=69, HT without pretransplant MCS (HT non-MCS)=92, and long-term MCS=144. Cohort average age=66.9±4.7 years, 78% male, 83% White, 78% married/partnered, and 71% with >high school education. HT non-MCS and long-term MCS groups experienced significant improvement in average visual analog scale scores within 6 months after surgery, sustained through 24 months of follow-up; the HT MCS group EuroQol-5-dimension-3L baseline visual analog scale score was higher than those of the other 2 groups and did not improve significantly through 24 months of follow-up. The average Kansas City Cardiomyopathy Questionnaire-12 overall summary score improved in all 3 groups (baseline–6 months, sustained through 24 months). Compared with HT non-MCS, the main effect of long-term MCS showed decrements of −11.2 (−17.3 to −5.1;
CONCLUSIONS:
HT MCS improvement in HRQOL varied by measure; HT non-MCS and long-term MCS improvement occurred through 24 months, regardless of measure. Domains of HRQOL improved after these surgeries, varying by surgical strategy and postoperative time period. Long-term MCS was associated with a decrease in HRQOL across time. These findings provide important information for patients considering treatment options.