title: Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation.
abstract: BACKGROUND
  The severity of pre-implantation heart failure may affect post-implantation health-related quality of life (HRQOL). The purpose of our study was to examine differences in HRQOL from before mechanical circulatory support (MCS) through 1 year after surgery by Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patient profiles.
  
  
  METHODS
  Data from 1,559 adults with advanced heart failure who received primary continuous-flow pumps between June 23, 2006, and March 31, 2010, and were enrolled in INTERMACS were analyzed. HRQOL data were collected using the EQ-5D-3L survey before implantation and at 3, 6, and 12 months after implantation. Statistical analyses included chi-square and t-tests, using all available data for each time period. Paired t-tests and sensitivity analyses were also conducted.
  
  
  RESULTS
  HRQOL was poor before MCS implantation among patients with INTERMACS profiles 1 to 7 and significantly improved after MCS implantation for all profiles. Stratified by INTERMACS profile, problems within each of the 5 dimensions of HRQOL (i.e., mobility, self-care, usual activities, pain, and anxiety/depression) generally decreased from before to after implantation. By 6 months after implantation, patients with all INTERMACS profiles reported similar frequencies of problems for all HRQOL dimensions. Paired t-tests and sensitivity analyses supported almost all of our findings.
  
  
  CONCLUSIONS
  HRQOL is poor among advanced heart failure patients with INTERMACS profiles 1 to 7 before MCS implantation and improves to similar levels for patients who remained on MCS 1 year after surgery. Patients have problems in HRQOL dimensions before and after MCS; however, the frequency of reporting problems decreases for all dimensions within most profiles across time.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, Illinois. Electronic address: kgrady@nmh.org.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David
authors.initials: D
authors.lastname: Naftel
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Lynne
authors.initials: L
authors.lastname: Stevenson
authors.affiliation: Departments of Epidemiology, Biostatistics, and Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Department of Biology, San Francisco State University, San Francisco, California.
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
authors.affiliation: Center for Circulatory Support, University of Michigan, Ann Arbor, Michigan.
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Susan
authors.initials: S
authors.lastname: Myers
authors.affiliation: the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Timothy
authors.initials: T
authors.lastname: Baldwin
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016019:Survival Analysis
keywords: INTERMACS; continuous-flow pump; health-related quality of life; heart failure; mechanical circulatory support