Impact of Adverse Events on Health-Related Quality of Life After Left Ventricular Assist Device Implantation - An STS INTERMACS Analysis

Abstract

<h3>Purpose</h3> Our aim was to quantify the impact of pre- and post-operative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. <h3>Methods</h3> Primary continuous flow durable LVAD implants, with or without concomitant valve surgery, between 2012-2019 in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) were identified. Multivariable modeling using general linear models assessed the impact of baseline patient characteristics, operative factors including device type, and post-implant adverse events (AEs) on HRQOL as assessed by the EQ-5D Visual Analog Scale [(VAS, 0 (worst) to 100 (best health state)] at 6 months and 3 years post-LVAD. Recent AEs were defined as occurring within 60 days prior to follow-up. <h3>Results</h3> Of 22,230 primary LVAD implants, 9,888 patients were alive with complete VAS data at 6 months, and 2,170 were alive with complete VAS data at 3 years follow-up. Median VAS improved from 40 [IQR 10-60] pre-implant to 75 [IQR 60-85] at 6 months and 75 [IQR 60-85] at 3 years (p<0.001). Pre-implant variables, including baseline VAS, were weakly associated with HRQOL, while post-implant AEs had a large negative association. Lower NYHA class at follow-up had a large positive association with HRQOL both at 6 months and 3 years. Recent stroke, recent respiratory failure, and recent renal dysfunction were most strongly associated with impaired HRQOL at 6 months, while recent renal dysfunction, recent respiratory failure, and recent infection were most strongly associated at 3 years (<b>Figure</b>). <h3>Conclusion</h3> AEs following LVAD implantation are most strongly associated with impaired HRQOL in both the early and late follow-up periods. Understanding the impact of AEs on HRQOL may assist clinicians and patients in shared decision making regarding LVAD therapy eligibility and timing of implant. Continued efforts to reduce post-LVAD AE burden are warranted to not only improve survival but also HRQOL.