Factors Associated with Change in Health-Related Quality of Life from Before to 24 Months After Surgery

Abstract

<h3>Purpose</h3> We sought to identify factors associated with long-term changes in health-related quality of life (HRQOL) among 3 groups of older patients (pts) with advanced heart failure (HF) undergoing heart transplantation (HT), with or without pre-transplant mechanical circulatory support (MCS), or long-term MCS, if ineligible for HT. <h3>Methods</h3> From 10/1/15-12/31/18, 393 pts (60-80 years) were enrolled from 13 U.S. sites, including 239 pts awaiting HT (118 with and 121 without MCS) and 154 long-term MCS pts. Of these, 151 pts (95 HT pts [34 with MCS and 61 without MCS before HT] and 56 long-term MCS pts) had 24-month follow-up data. The EQ-5D Visual Analog Scale (VAS; 0-100 [worst-best health state]) and KCCQ-12 overall summary score (OSS; 0-100 [poor-excellent health status]) were collected at baseline (closest to surgery) and 24-months. Analyses included ANOVA, paired t-tests, and multivariable linear regression. <h3>Results</h3> Average age at HT or long-term MCS implant (n=151) was 66.8 ±4.5 years, 80% were male, and 81% were white. At baseline, long-term MCS pts, compared with HT pts awaiting HT with MCS and those awaiting HT on medical therapy, had the lowest VAS scores (48.7±20.8 vs 65.9±21.0 vs 51.6±25.4, p=0.002) and KCCQ-12 OSS (37.1±20.9 vs 56.5±25.6 vs 46.4±20.5, p<0.001). HRQOL improved significantly in all 3 groups by 24 months (p<0.001); however, long-term MCS pts, compared with HT pts awaiting HT with MCS and those awaiting HT on medical therapy, still had the lowest VAS scores (70.9±19.7 vs 81.8±14.6 vs 86.2±12.1, p<0.001) and KCCQ-12 OSS (63.3±24.1 vs 85.3±16.0 vs 90.0±14.3, p<0.001). Multivariable models (Table) indicate that baseline HRQOL and undergoing HT, with or without MCS, are the strongest predictors of improvement in HRQOL. <h3>Conclusion</h3> Among pts with advanced HF requiring HT or MCS, improvement in HRQOL was greatest in those undergoing HT with or without MCS pre-HT and those with worse baseline HRQOL. These findings may inform advanced HF pts of anticipated HRQOL outcomes with alternative therapies.