title: Pre-operative health status and outcomes after continuous-flow left ventricular assist device implantation.
abstract: BACKGROUND
  Health status predicts adverse outcomes in heart failure and cardiac surgery patients, but its prognostic value in left ventricular assist device (LVAD) placement is unknown.
  
  
  METHODS
  We examined the association of pre-operative health status, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), with survival and hospitalization after LVAD using the KCCQ score as a continuous variable and stratified by KCCQ score quartile plus missing KCCQ in 1,125 clinical trial participants who received the HeartMate II (Thoratec Corp, Pleasanton, CA) as destination therapy (n = 635) or bridge to transplantation (n = 490).
  
  
  RESULTS
  The mean pre-operative KCCQ score was 29.4 ± 18.7 among survivors (n = 719), and 27.1 ± 18.3 (n = 406) in those who died. In time-to-event analysis for all available follow-up using health status as a continuous variable, the pre-operative KCCQ score did not correlate with overall mortality after LVAD implantation (p = 0.178). Small absolute differences were seen between the pre-operative KCCQ quartile and 30-day survival (Q4 95% vs. Q1 89% vs. missing 87%; p = 0.0009 for trend), 180-day survival (Q4 83% vs. Q1 76% vs missing 79%; p = 0.060 for trend), and days hospitalized at 180 days (Q4 29.8 ± 25.6 vs. Q1 34.1 ± 27.1 vs. missing 36.5 ± 29.9 days; p = 0.009 for trend).
  
  
  CONCLUSIONS
  Our findings suggest that pre-operative health status has limited association with outcomes after LVAD implantation. Although these data require further study in a diverse population, mechanical circulatory support may represent a relatively unique clinical situation, distinct from heart failure and other cardiac surgeries, in which heart failure-specific health status measures may be largely reversed.
authors.affiliation: Department of Internal Medicine, Stanford University Hospital, Palo Alto, California.
authors.forename: Kelsey M
authors.initials: KM
authors.lastname: Flint
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.forename: Kartik S
authors.initials: KS
authors.lastname: Sundareswaran
authors.forename: Joann
authors.initials: J
authors.lastname: Lindenfeld
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrar
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy*
keywords: health status; health-related quality of life; heart failure; mechanical circulatory support; risk prediction