title: Preoperative Determinants of Quality of Life and Functional Capacity Response to Left Ventricular Assist Device Therapy.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) improve survival, quality of life (QOL), and functional capacity (FC) among patients with end-stage heart failure. Few data are available regarding characteristics associated with QOL and FC response.
  
  
  RESULTS
  Patients enrolled in the Heartmate II clinical trials that were alive with ongoing LVAD support at 6 months were included. QOL response criteria included scoring above the lowest quartile on either the Minnesota Living With Heart Failure Questionnaire or the Kansas City Cardiomyopathy Questionnaire. FC responder criteria included improvement in 6-minute walk distance (6MWD) >70 meters from baseline, a 6MWD >220 meters at 6 months, or New York Heart Association functional class I or II. Independent variables associated with QOL nonresponse included history of diabetes (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.20-2.78), lower mean pulmonary arterial pressure (OR 0.97, 95% CI 0.95-0.99), or a Heartmate II right ventricular risk score >2 (OR 1.77, 95% CI 1.00-3.12). Variables associated with FC nonresponse included history of COPD (OR 1.92, 95% CI 1.22-3.03) or diabetes (OR 1.52, 95% CI 1.01-2.27). Compared with responders, QOL and FC nonresponders had reduced long-term survival.
  
  
  CONCLUSIONS
  Preoperative comorbidities, including diabetes, COPD, and right heart failure, may limit the QOL and FC response to LVAD therapy and should be considered during the shared decision-making process.
authors.affiliation: Divisions of Cardiology, Tufts Medical Center, Boston, Massachusetts. Electronic address: mkiernan@tuftsmedicalcenter.org.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kiernan
authors.affiliation: Thoratec Corporation, Pleasanton, California.
authors.forename: Kartik S
authors.initials: KS
authors.lastname: Sundareswaran
authors.affiliation: Division of Cardiac Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Duc Thinh
authors.initials: DT
authors.lastname: Pham
authors.affiliation: Divisions of Cardiology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Navin K
authors.initials: NK
authors.lastname: Kapur
authors.affiliation: Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.affiliation: Richard DeVos Heart and Lung Transplant Program, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Martin
authors.initials: M
authors.lastname: Strueber
authors.affiliation: Thoratec Corporation, Pleasanton, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrar
authors.affiliation: Divisions of Cardiology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: DeNofrio
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
mesh_terms: D000368:Aged; D002423:Cause of Death; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006334:Heart Function Tests; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Left ventricular assist device; exercise tolerance; functional capacity; heart failure; predictors; quality of life; survival