Background
Destination therapy left ventricular assist devices (DT LVADs) are being increasingly implanted in older adults. Older patients are at increased risk for mortality and morbidity post LVAD, which may impact their health-related quality of life (HRQOL). We sought to examine change in HRQOL by age from before to 1 year after DT LVAD implant and identify factors associated with change.
Methods
Data were collected from 1,470 continuous flow DT LVAD patients at 108 institutions participating in INTERMACS from January 21, 2010 to March 31, 2012. Patients were divided into three cohorts: <60 years (n=457), 60-69 years (n=520), and ≥70 years (n=493). HRQOL was measured using the generic EQ-5D-3L. Data were collected pre-implant and 3, 6, and 12 months post-implant. Statistical analyses included descriptive statistics, Kaplan-Meier survival analyses, and multivariable regression analyses.
Results
HRQL improved in all patients. Generally, older patients reported better HRQOL than younger patients pre implant (≥70 yrs, mean=40; 60-69 yrs, mean=33; and < 60 yrs, mean=31, p<0.0001) and 1 year post implant (≥70 yrs, mean=77; 60-69 yrs, mean=72; and < 60 yrs, mean=70, p=0.01) using the EQ-5D visual analog scale (VAS), with 0 = worst imaginable health state and 100 = best imaginable health state. The magnitude of improvement in EQ-5D scores from pre- to 1 year post LVAD was similar in all age groups (≥70 yrs, mean change=33; 60-69 yrs, mean change=35; and < 60 yrs, mean change=35, p=0.77). Factors associated with improvement in HRQOL from before to 1 year after implant were a lower VAS score pre implant and fewer re-hospitalizations after implant (R2=61.3%, p< 0.0001).
Conclusions
Older patients reported better HRQOL than younger patients before and after LVAD implantation. The magnitude of improvement was similar for all age groups, with more than 70% of all patients evidencing clinically important increases (>10 points on the VAS). Re-hospitalization appears to reduce the magnitude of improvement.