Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation.
BACKGROUND
The HeartMate vented electric left ventricular assist device has been approved for use as destination therapy. Thus, the study of quality-of-life outcomes, as well as morbidity and mortality, is imperative. The purpose of our study was to describe change with time (from 1 month to 1 year) in patients who received a HeartMate vented electric left ventricular assist device as a bridge to heart transplantation and to identify quality-of-life predictors of survival after left ventricular assist device implantation.


METHODS
A nonrandom sample of 78 patients who received a HeartMate vented electric left ventricular assist device (primarily middle-aged, white married males) who had quality-of-life data at 1, 2, 3, 6, 9, or 12 months after implant was the subject of this report. The sample size decreased with time primarily because of heart transplantation. Patients completed the following booklets of questionnaires: Quality of Life Index, Rating Question Form, Heart Failure Symptom Checklist, and Sickness Impact Profile. Analyses included both descriptive analyses and modeling procedures (mixed-effects models and Cox proportional hazards models).


RESULTS
Quality-of-life outcomes were fairly good and stable from 1 month to 1 year after HeartMate vented electric left ventricular assist device implantation. Both positive and negative changes were detected in all quality-of-life domains (physical and occupational function, social interaction, somatic sensation, and psychological state) after left ventricular assist device insertion. Items from the physical domain of quality of life, specifically walking and dressing oneself, were significantly associated with the risk of dying after left ventricular assist device implantation.


CONCLUSIONS
Identifying poor quality-of-life outcomes within 1 year after left ventricular assist device implantation provides direction to develop strategies to improve outcomes. Physical and occupational rehabilitation, psychosocial intervention, and monitoring symptom distress and physical disability may contribute to improved quality-of-life outcomes and survival after left ventricular assist device implantation.
Grady
Kathleen L
KL
Section of Cardiology, Rush Heart Failure and Cardiac Transplant Program, Rush University Medical Center, Chicago, Illinois 60612-3824, USA. kgrady@rush.edu
Meyer
Peter M
PM
Dressler
Diane
D
Mattea
Annette
A
Chillcott
Suzanne
S
Loo
Alice
A
White-Williams
Connie
C
Todd
Barbara
B
Ormaza
Sophia
S
Kaan
Annemarie
A
Costanzo
Maria Rosa
MR
Piccione
William
W
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019736:Prostheses and Implants; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate