Change in Health-Related Quality of Life from before to 2 Years after Surgery: Findings from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support (SUSTAIN-IT) Study

Abstract

<h3>Purpose</h3> Heart transplantation (HT) and mechanical circulatory support (MCS) as destination therapy (DT) improve outcomes for older patients with heart failure, yet comparative benefits of HT versus DT MCS are unknown. We compared health-related quality of life (HRQOL) before and 2 years (yrs) after surgery in patients aged 60-80 yrs undergoing HT (with MCS [HT MCS] or without MCS [HT non-MCS] while awaiting HT) or DT MCS. <h3>Methods</h3> Among 393 patients at 13 U.S. sites awaiting HT (n=239; 118 with MCS, 121 without MCS; 67% transplanted) and DT MCS (n=154) enrolled between 10/1/15-12/31/18, we collected self-report data on: HRQOL (EQ-5D-3L Visual Analog Scale [VAS]: 0-100=worst to best) and (KCCQ-12: 0-100=lowest to highest), depressive symptoms (PHQ-8: 0-24=fewer to more) and anxiety (STAI-state: 20-80=lower to higher]). There were 125 patients at 2 year follow up. Statistical analyses included paired t-tests, chi-square tests, and baseline-adjusted linear regression. <h3>Results</h3> The majority of patients were white and male. DT MCS patients were older (DT = 68.6±5.2 vs HT MCS = 64.4±3.3 vs HT non-MCS = 64.0±2.9 years, p<0.001) and had more co-morbidities (DT = 5.0±2.2 vs HT MCS = 4.2±2.1 vs HT non-MCS = 3.9±1.8, p<0.001). Baseline HRQOL scores were worse in patients before DT MCS vs before HT with MCS (p<0.001) and without MCS (p<0.003). HRQOL improved in all 3 groups from before to 2 yrs post-surgery (p<0.0001), but 2 yr HRQOL scores were lower in the DT MCS group than both HT groups (p<0.03). Depressive symptoms and anxiety decreased over time in all 3 groups (p<0.001), but DT patient scores were worse than non-MCS HT patient scores at 2 yrs after surgery (p<0.03) (Figure). <h3>Conclusion</h3> HRQOL and mood improved in all 3 groups from baseline to 2 years after surgery. DT MCS patient scores were worse at baseline and did not improve to the level of HT recipients over time. These unique findings may guide HRQOL-related therapeutic strategies.