title: Age and gender differences and factors related to change in health-related quality of life from before to 6 months after left ventricular assist device implantation: Findings from Interagency Registry for Mechanically Assisted Circulatory Support.
abstract: Gaps in the literature exist regarding health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) surgery. The purposes of our study were to describe HRQOL over time, by age and gender, and identify risk factors for poor HRQOL early after LVAD implant.
  
  
  
  Patients (n = 7,353) from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database received a continuous-flow LVAD as a primary implant at 133 United States hospitals. Of these, 5,640 patients had pre-LVAD HRQOL data, 3,353 patients had 6-month post-LVAD HRQOL data, and 2,748 patients had data at both times. HRQOL was measured using the EQ-5D-3L (Euro-Qol) instrument. Data were collected pre-implant and 3 and 6 months post-operatively. Statistical analyses included chi-square test, t-test, Pearson correlation coefficients, and multiple regression analysis.
  
  
  
  Overall HRQOL and dimensions of HRQOL improved from before to 6 months after device implant when examined by age and gender. However, younger patients and women reported significantly more problems regarding all dimensions before implant and significantly more problems regarding pain/discomfort and anxiety/depression at 3 and 6 months after implant. An increase in overall HRQOL from before to 6 months after implant was related to pre-implant INTERMACS Level 1. Factors related to a decrease in HRQOL from before to 6 months after implant were listed for heart transplant before surgery, comorbidities, better preoperative HRQOL, adverse events within 6 months after implant, bridge to transplant moderately likely and unlikely, and New York Heart Association Functional Classification IV at 6 months after LVAD (R(2) = 41%).
  
  
  
  Overall HRQOL and dimensions of HRQOL improve in sub-groups of patients from before to 6 months after surgery, although differences in improvement exist. Adverse events are risk factors for decreased HRQOL across time and support the ongoing need to improve device technology with the aim of reducing adverse events.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: kgrady@nmh.org.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
authors.affiliation: Comprehensive Transplant Center, Ohio State University Medical Center, Columbus, Ohio.
authors.lastname: Sherri Wissman
authors.affiliation: Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama.
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.affiliation: Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama.
authors.forename: Susan
authors.initials: S
authors.lastname: Myers
authors.affiliation: Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York.
authors.forename: Annetine
authors.initials: A
authors.lastname: Gelijins
authors.affiliation: Departments of Medicine and Population Health Science and Policy, Mount Sinai Medical Center, New York, New York.
authors.forename: Alan
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.affiliation: Department of Medicine, Cleveland Clinic Foundation Lerner College of Medicine, Cleveland, Ohio.
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.affiliation: Division of Cardiovascular Research, St. Luke's Mid America Heart Institute, St. Luke's Mid America Heart Institute and University of Missouri Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama.
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
mesh_terms: D005260:Female; D006333:Heart Failure; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D011788:Quality of Life; D012042:Registries; D016896:Treatment Outcome
keywords: age; gender; health-related quality of life; left ventricular assist device; risk factors