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Type: Journal article
Title: Change in health-related quality of life from before to after destination therapy mechanical circulatory support is similar for older and younger patients: analyses from INTERMACS
Author: Grady, K.
Naftel, D.
Myers, S.
Dew, M.
Weidner, G.
Spertus, J.
Idrissi, K.
Lee, H.
McGee, E.
Kirklin, J.
Citation: Journal of Heart and Lung Transplantation, 2015; 34(2):213-221
Publisher: Elsevier
Issue Date: 2015
ISSN: 1053-2498
Statement of
Kathleen L. Grady, David C. Naftel, Susan Myers, Mary Amanda Dew, Gerdi Weidner, John A. Spertus, Katharine Idrissi, Hochang B. Lee, Edwin C. McGee and James K. Kirklin
Abstract: BACKGROUND:Destination therapy left ventricular assist devices (DT LVADs) are being implanted in older adults on an increasing basis. Older patients have a higher risk for mortality and morbidity post-LVAD, which may impact their health-related quality of life (HRQOL). We aimed to determine the change in HRQOL by age from before implant to 1 year after DT LVAD implant and identify factors associated with the change. METHODS:Data were collected from 1,470 continuous-flow DT LVAD patients at 108 institutions participating in INTERMACS from January 21, 2010 to March 31, 2012. Patients were divided into three cohorts: <60 years of age (n = 457); 60 to 69 years of age (n = 520); and ≥70 years of age (n = 493). HRQOL was measured using the generic EuroQol instrument (EQ-5D-3L). Data were collected pre-implant and 3, 6 and 12 months post-implant. Statistical analyses included descriptive statistics, Kaplan-Meier survival analyses and multivariable regression analyses. RESULTS:HRQOL improved in all patients. Generally, older patients reported better HRQOL than younger patients pre-implant (≥70 years: mean 40; 60 to 69 years: mean 33; and <60 years: mean 31; p < 0.0001) and 1 year post-implant (≥70 years: mean 77; 60 to 69 years: mean 72; <60 years: mean 70; p = 0.01) using the EQ-5D visual analog scale (VAS), with 0 = worst imaginable health state and 100 = best imaginable health state. The magnitude of improvement in EQ-5D scores from pre-implant to 1-year post-LVAD implant was similar in all age groups (≥70 years: mean change 33; 60 to 69 years: mean change 35; <60 years: mean change 35; p = 0.77). Factors associated with improvement in HRQOL from before to 1 year after implant were a lower VAS score pre-implant and fewer rehospitalizations post-implant (R(2) = 61.3%, p < 0.0001). CONCLUSIONS:Older patients reported better HRQOL than younger patients before and after LVAD implantation. The magnitude of improvement was similar for all age groups, with >70% of all patients showing clinically significant increases (>10 points on the VAS). Rehospitalization appears to reduce the magnitude of improvement.
Keywords: Quality oflife; ventricular assist devices; left ventricularassist devices; mechanical circulatory support; destination therapy; age
Rights: © 2015 International Society for Heartand Lung Transplantation.All rights reserved.
RMID: 0030104370
DOI: 10.1016/j.healun.2014.10.001
Appears in Collections:Medicine publications

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