Adverse events after device implant tied to quality of life measures for end-stage HF
Key takeaways:
- Early adverse events after left ventricular device implantation significantly impact health-related quality of life in HF.
- Preoperative patient characteristics had a small effect on quality of life scores.
Recent adverse events soon after receiving a left ventricular assist device, such as major organ dysfunction, have the largest effect on scores measuring health-related quality of life, according to a patient registry analysis.
In an analysis of more than 12,000 patients with end-stage HF who received an LVAD, researchers also found that patient characteristics and device implant strategies had small effects on health-related quality of life.
“We found in a large multicenter cohort of durable LVAD patients that health-related quality of life improves substantially on support, and that the main drivers of decreased quality of life are adverse events following LVAD implant rather than baseline comorbidities or risk factors,” Arman Kilic, MD, FACS, FACC, the John M. Kratz Endowed Chair in Cardiac Surgery and surgical director of the Heart Failure and Heart Transplant Program at Medical University of South Carolina, told Healio. “The clinical implications are that LVADs offer an opportunity to improve quality of life for patients with end-stage HF who often have debilitating symptoms. We must also continue to share best practices and develop new and improved ways of minimizing adverse event rates after LVAD therapy, although rates have significantly declined in recent years.”
Kilic and colleagues analyzed data from patients who received primary durable LVAD implants between 2012 and 2019, using the Interagency Registry for Mechanically Assisted Circulatory Support. Researchers assessed the impact of baseline characteristics and adverse events after implantation on health-related quality of life, using the EQ-5D Visual Analog Scale at 6 months (n = 9,888) and 3 years (n = 2,170). Visual analog scale (VAS) scores range from 0 (worst health state) to 100 (best health state).
The findings were published in the Journal of Heart and Lung Transplantation.
The mean VAS score improved from 38.2 to 70.7 at 6 months and from a mean of 40.1 to 70.3 at 3 years. Kansas City Cardiomyopathy Questionnaire score improved from a mean of 28.2 to 64.3 at 6 months and from a mean of 29.8 to 63 at 3 years.
In linear models assessing variables before and after LVAD implants, factors such as baseline VAS score had only small effect size on health-related quality of life; however, adverse events after receiving an LVAD had large negative effect sizes, according to the researchers. At 6 months, adverse events with the largest negative effects included recent stroke, respiratory failure and renal dysfunction. At 3 years, recent renal dysfunction, respiratory failure and infection had the largest negative effect on health-related quality of life.
The researchers noted that the findings highlight the need for more consistent data collection on patient-reported outcomes, adding that more focused analyses are needed to identify pre- and postoperative patient characteristics associated with changes in health-related quality of life during the early follow-up period. The cohort also contains a large proportion of patients who received earlier-generation LVADs.
“Novel methods of risk modeling, data and best practice sharing and consensus statements from centers that perform well in low rates of specific adverse events are needed so that these practices can be generalized,” Kilic told Healio.
For more information:
Arman Kilic, MD, FACS, FACC, can be reached at kilica@musc.edu; Twitter: @armankilicmd.
Collapse