Longitudinal change in health-related quality of life (HRQOL) by left ventricular assist device (LVAD) implant strategy is unknown. The purpose of this study was to examine if generic and heart failure-specific HRQOL differs by pre-operative implant strategy from pre-implant to 2 years (yrs) post implant. Methods: Data from adult patients (pts) in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) were stratified into three groups: destination therapy (DT), bridge to transplant (BTT), and bridge to candidacy (BTC [BTT likely, moderately likely, and unlikely]). Data were collected pre-implant and 1yr and 2yrs post implant. HRQOL was measured with the EQ-5D-3L generic survey visual analog scale [VAS health status, 0= worst-100= best), and heart failure (HF)-specific KCCQ-12 overall summary (OS) score of 4 domains (physical limitations, symptom frequency, quality of life, and social limitations). Statistical analyses included descriptive statistics, chi square, analysis of variance, and paired t-tests. Results: Between 04/01/08-06/30/13, 7227 and 4505 pts who received primary continuous flow LVADs had VAS and KCCQ-12 HRQOL data, respectively, at baseline. Longitudinally, mean VAS scores for all 3 groups improved significantly from pre to 2 yrs post implant (figure 1). Similar to the VAS, KCCQ-12 OS scores improved over time for all 3 groups (figure 1). Sensitivity analyses, using only paired data (pre implant and 2 years post implant), for both the EQ-5D-3L VAS and KCCQ-12 OS support these findings. Conclusion: Overall, HRQOL improves from before to 2 yrs after LVAD implant for pts with all 3 implant strategies, assessed by both a generic and HF-specific instrument. These findings suggest that all implant strategy groups, regardless of intent to transplant or not, may derive HRQOL-related benefit from before to mid-term after LVAD implantation.
collected from the medical record and self-administered questionnaires. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ) (range, 0-27). SOC was assessed by the 13-item SOC scale by Antonovsky et al (range, 13-91). To assess an association of depression with SOC after adjustment for age, logistic regression analysis was performed with the presence of mild or more severe depression (defined as the PHQ score of more than 5) as dependent variable. Results: At 3 months after LVAD implantation, depressive symptoms were significantly improved (PHQ score, 6.7±5.6 to 4.9±4.8, p= 0.02), but still 27% (n= 9) had mild (10 > PHQ score ≥ 5) and 18% (n= 6) had moderate or severe depression (PHQ score ≥ 10). Preoperative SOC (54.8±7.7) did not influence on postoperative depressive symptoms (n= 24, r=-0.06, p= 0.77), whereas postoperative higher SOC (53.8±7.3) was significantly related to less depressive symptoms (n= 33, ρ =-0.53, p< 0.01). Logistic regression analysis showed that postoperative higher SOC was associated with a decrease risk of depression independent of age (odds ratio= 0.87, 95% confidence inter-val= 0.77-0.98, p= 0.02). Conclusion: Although depressive symptoms are lower at 3 months after LVAD implantation, depression is still a common mental problem reported by 45% of the patients. Postoperative lower SOC is an important factors to identify patients at high risk for depression.
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