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

Abstract

Purpose Heart transplantation (HT) with or without prior mechanical circulatory support (MCS) and MCS as destination therapy (DT) are life-saving options for 60-80 year-old patients (pts) with advanced heart failure (HF). We prospectively collected and compared pts' health-related quality of life (HRQOL) before and 6 months (mos) after surgery in pts undergoing HT (with or without MCS) and DT MCS. Methods Among 344 pts from 13 U.S. sites awaiting HT (n=207; 100 awaiting HT with MCS and 107 awaiting HT without MCS) and DT MCS (n=137) between 10/1/15-9/15/18, we collected generic (EQ-5D-3L Visual Analog Scale [VAS]: 0-100=worst to best) and HF-specific HRQOL (KCCQ-12: 0-100=lowest to highest), as well as depressive (PHQ-8: 0-24=fewer to more) and anxiety (STAI-state: 20-80=lower to higher]) symptoms. Statistical analyses included t-tests , chi-square tests , and baseline-adjusted linear models. Results The majority of pts were white, male, and well-educated. The DT MCS group was older than the HT group (DT = 68.6±5.1 vs HT with MCS = 64.5±3.3 vs HT without MCS = 64.0±2.9 years, p Depressive symptoms and anxiety did not change significantly over time in the HT with MCS group, although these scores were similar among all three groups at 6 mos (Figure panels A-D). Conclusion While all three groups improved over time, HRQOL at 6 mos was best in those undergoing HT without MCS. Change in depressive symptoms and anxiety varied by group. These data provide unique insights into pts’ experiences after alternative surgical treatments for advanced HF.