Post-Discharge Quality of Life with a Long-Term Ventricular Assist Device: Focus on Functional Disability and Impact of Health Status

Abstract

Reported outcomes after left ventricular assist device (LVAD) implantation include mortality, hospital readmission and severe adverse events. We have less information about patients' perceptions of their quality of life (QOL) after hospital discharge. We conducted a prospective two-center international pilot study to assess at-home functional capacity and QOL following LVAD implantation as a bridge to transplant (BTT) or destination therapy (DT). 124 patients ≥ 30 days after discharge post-implantation were assessed telephonically or during on-site clinic visits. WHODAS 2.0 assesses disability in cognition, mobility, self-care, interpersonal relationships, work/household roles and societal participation. EQ-5D assesses impact of health status on 5 life dimensions. EQ-VAS reflects health self-assessment from 0-100 (worst to best imaginable). Mean patient age was 57.5±15.2 yrs; 15% female; 47% >1 yr post-implantation; 56% DT; 67% had HeartMate 3. Disability was minimal in 67% but moderate to severe in 33% (Figure). In the EQ-5D, moderate to extreme problems were reported with usual activities (33%), pain (32%), mobility (31%), self-care (24%) and anxiety (22%). At assessment, 42% reported an EQ-VAS ≥70, but 25% reported <50. 96% of patients in the best quintile of EQ-VAS reported no or mild disability (p < 0.01), but so did 30% of patients in the worst quintile. The majority of LVAD out-patients reported good functional capacity, little impact of their health on major life domains, and high subjective health self-assessment. Yet a substantial minority did not enjoy a high QOL. A good EQ-VAS correlates with high functional ability, but some patients have a poor EQ-VAS even without disability. Routine assessment of functional ability and health status is feasible in post-discharge LVAD patients. Standardized, regular assessments could help us identify factors associated with a high versus low QOL.