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Grady KL, Burns JL, Allen LA, Stehlik J, Teuteberg J, McIlvennan CK, Kirklin JK, Beiser DG, Lindenfeld J, Denfeld QE, Lee CS, Kiernan M, Cella D, Klein L, Walsh MN, Ruo B, Adler E, Rich J, Pham DT, Yancy C, Murks C, Bedjeti K, Hahn EA. Association of Novel Ventricular Assist Device Self-report Measures With Overall Health-Related Quality of Life. J Cardiovasc Nurs 2024:00005082-990000000-00221. [PMID: 39259580 DOI: 10.1097/jcn.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Few study authors examined factors influencing health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) implantation. OBJECTIVE The purpose of this study was to determine whether 5 novel self-report measures and other variables were significantly associated with overall HRQOL at 3 months after LVAD surgery. METHODS Patients were recruited between October 26, 2016, and February 29, 2020, from 12 US sites. Data were collected before LVAD implantation and at 3 months post LVAD implantation. Overall HRQOL measures included the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) overall summary score (OSS) and EuroQol 5-dimension- 3L visual analog scale. Potential factors associated with overall HRQOL included 5 novel self-report measures (Satisfaction with Treatment, Being Bothered by VAD Self-care and Limitations, VAD Team Communication, Self-efficacy regarding VAD Self-care, and Stigma), and demographic and clinical characteristics. Statistics included regression analyses. RESULTS Of enrollees, 242 completed self-report measures at baseline, and 142 completed measures 3 months postoperatively. Patients were 55 ± 13 years old, with 21% female, 24% non-White, 39% high school or lower educated, and 47% destination therapy. Using the KCCQ-12 OSS, higher Satisfaction with Treatment was associated with a higher KCCQ-12 OSS; Being Bothered by VAD Self-care and Limitations, high school or lower education, chest incision pain, cardiac dysrhythmias within 3 postoperative months, and peripheral edema were associated with a worse KCCQ-12 OSS (R2 = 0.524). Factors associated with a worse 3-month EuroQol 5-dimension-3L visual analog scale were female sex, adverse events within 3 months post implantation (cardiac dysrhythmias, bleeding, and venous thrombosis), and chest incision pain (R2 = 0.229). No factors were associated with a higher EuroQol 5-dimension-3L visual analog scale score at 3 months. CONCLUSIONS Two novel measures, demographics, postimplantation adverse events, and symptoms were associated with post-LVAD KCCQ-12 OSS early after surgery.
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Grady KL, Dew MA, Pagani FD, Spertus JA, Hsich E, Yuzefpolskaya M, Lampert B, Kirklin JK, Petty M, Kao A, Yancy C, Hartupee J, Pamboukian SV, Johnson M, Murray M, Wu T, Andrei AC. A comparison of quality-adjusted life years in older adults after heart transplantation versus long-term mechanical support: Findings from the SUSTAIN-IT study. J Heart Lung Transplant 2024; 43:1422-1433. [PMID: 38762215 PMCID: PMC11305942 DOI: 10.1016/j.healun.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The quality-adjusted life year (QALY) measures disease burden and treatment, combining overall survival and health-related quality of life (HRQOL). We estimated QALYs in 3 groups of older patients (60-80 years) with heart failure (HF) who underwent heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or HT without pre-transplant MCS [HT Non-MCS]) or long-term MCS (destination therapy). We also identified factors associated with gains in QALYs through 24 months follow-up. METHODS Of 393 eligible patients enrolled (10/1/15-12/31/18) at 13 U.S. sites, 161 underwent HT (n = 68 HT MCS, n = 93 HT Non-MCS) and 144 underwent long-term MCS. Survival and HRQOL data were collected through 24 months. QALY health utilities were based on patient self-report of EQ-5D-3L dimensions. Mean-restricted QALYs were compared among groups using generalized linear models. RESULTS For the entire cohort, mean age in years closest to surgery was 67 (standard deviation, SD: 4.7), 78% were male, and 83% were White. By 18 months post-surgery, sustained significant differences in adjusted average ± SD QALYs emerged across groups, with the HT Non-MCS group having the highest average QALYs (24-month window: HT Non-MCS = 22.58 ± 1.1, HT MCS = 19.53 ± 1.33, Long-term MCS = 19.49 ± 1.3, p = 0.003). At 24 months post-operatively, a lower gain in QALYs was associated with HT MCS, long-term MCS, a lower pre-operative LVEF, NYHA class III or IV before surgery, and an ischemic or other etiology of HF. CONCLUSIONS Determination of QALYs may provide important information for policy makers and clinicians to consider regarding benefits of HT and long-term MCS as treatment options for older patients with HF.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois.
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - John A Spertus
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eileen Hsich
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Brent Lampert
- Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | | | - Michael Petty
- Department of Nursing, University of Minnesota Medical Center, Fairview, Minnesota
| | - Andrew Kao
- Cardiovascular Disease, Advanced Heart Failure and Transplant Cardiology, St. Luke's Health System, Kansas City, Missouri
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Justin Hartupee
- Department of Medicine, Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Maryl Johnson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Margaret Murray
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Tingqing Wu
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Beese S, Avşar TS, Price M, Quinn D, Lim HS, Dretzke J, Ogwulu CO, Barton P, Jackson L, Moore D. Clinical and cost-effectiveness of left ventricular assist devices as destination therapy for advanced heart failure: systematic review and economic evaluation. Health Technol Assess 2024; 28:1-237. [PMID: 39189844 PMCID: PMC11367304 DOI: 10.3310/mlfa4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024] Open
Abstract
Background Selected patients with advanced heart failure ineligible for heart transplantation could benefit from left ventricular assist device therapy as 'destination therapy'. There is evidence of the efficacy of destination therapy; however, it is not currently commissioned within the United Kingdom National Health Service due to the lack of economic evidence. Objective What is the clinical and cost-effectiveness of a left ventricular assist device compared to medical management for patients with advanced heart failure ineligible for heart transplantation (destination therapy)? Methods A systematic review of evidence on the clinical and cost-effectiveness of left ventricular assist devices as destination therapy was undertaken including, where feasible, a network meta-analysis to provide an indirect estimate of the relative effectiveness of currently available left ventricular assist devices compared to medical management. For the systematic reviews, data sources searched (up to 11 January 2022) were Cochrane CENTRAL, MEDLINE and EMBASE via Ovid for primary studies, and Epistemonikos and Cochrane Database of Systematic Reviews for relevant systematic reviews. Trial registers were also searched, along with data and reports from intervention-specific registries. Economic studies were identified in EconLit, CEA registry and the NHS Economic Evaluation Database (NHS EED). The searches were supplemented by checking reference lists of included studies. An economic model (Markov) was developed to estimate the cost-effectiveness of left ventricular assist devices compared to medical management from the United Kingdom National Health Service/personal social service perspective. Deterministic and probabilistic sensitivity analyses were conducted to explore uncertainties. Where possible, all analyses focused on the only currently available left ventricular assist device (HeartMate 3TM, Abbott, Chicago, IL, USA) in the United Kingdom. Results The clinical effectiveness review included 134 studies (240 articles). There were no studies directly comparing HeartMate 3 and medical management (a randomised trial is ongoing). The currently available left ventricular assist device improves patient survival and reduces stroke rates and complications compared to earlier devices and relative to medical management. For example, survival at 24 months is 77% with the HeartMate 3 device compared to 59% with the HeartMate II (MOMENTUM 3 trial). An indirect comparison demonstrated a reduction in mortality compared to medical management [relative risk of death 0.25 (95% confidence interval 0.13 to 0.47); 24 months; this study]. The cost-effectiveness review included 5 cost analyses and 14 economic evaluations covering different generations of devices and with different perspectives. The reported incremental costs per quality-adjusted life-year gained compared to medical management were lower for later generations of devices [as low as £46,207 (2019 prices; United Kingdom perspective; time horizon at least 5 years)]. The economic evaluation used different approaches to obtain the relative effects of current left ventricular assist devices compared to medical management from the United Kingdom National Health Service/personal social service perspective. All gave similar incremental cost-effectiveness ratios of £53,496-58,244 per quality-adjusted life-year gained - lifetime horizon. Model outputs were sensitive to parameter estimates relating to medical management. The findings did not materially differ on exploratory subgroup analyses based on the severity of heart failure. Limitations There was no direct evidence comparing the clinical effectiveness of HeartMate 3 to medical management. Indirect comparisons made were based on limited data from heterogeneous studies regarding the severity of heart failure (Interagency Registry for Mechanically Assisted Circulatory Support score distribution) and possible for survival only. Furthermore, the cost of medical management of advanced heart failure in the United Kingdom is not clear. Conclusions Using cost-effectiveness criteria applied in the United Kingdom, left ventricular assist devices compared to medical management for patients with advanced heart failure ineligible for heart transplant may not be cost-effective. When available, data from the ongoing evaluation of HeartMate 3 compared to medical management can be used to update cost-effectiveness estimates. An audit of the costs of medical management in the United Kingdom is required to further decrease uncertainty in the economic evaluation. Study registration This study is registered as PROSPERO CRD42020158987. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128996) and is published in full in Health Technology Assessment; Vol. 28, No. 38. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sophie Beese
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tuba S Avşar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Institute of Epidemiology and Health, University College London, London, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Quinn
- Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hoong S Lim
- Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janine Dretzke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chidubem O Ogwulu
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pelham Barton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Noufi P, Anderson KM, Crowell N, White Y, Molina E, Rao SD, Groninger H. Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00048-X. [PMID: 38705515 DOI: 10.1016/j.jaclp.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In critically ill patients, delirium is a prognostic indicator of morbidity and mortality. OBJECTIVE This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation. METHODS This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates. RESULTS In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant. CONCLUSIONS In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.
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Affiliation(s)
- Paul Noufi
- Palliative Care, MedStar Harbor Hospital, Baltimore, MD; Georgetown University School of Medicine, Washington, DC.
| | | | - Nancy Crowell
- Georgetown University School of Nursing, Washington, DC
| | - Yasmine White
- Georgetown University School of Medicine, Washington, DC
| | - Ezequiel Molina
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Sriram D Rao
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Hunter Groninger
- Georgetown University School of Medicine, Washington, DC; Palliative Care, MedStar Washington Hospital Center, Washington, DC
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Jakstaite AM, Luedike P, Wernhart S, Kamler M, Ruhparwar A, Rassaf T, Papathanasiou M. Erectile dysfunction and quality of life in patients under left ventricular assist device support - an unspoken issue. IJC HEART & VASCULATURE 2023; 48:101263. [PMID: 37663612 PMCID: PMC10469048 DOI: 10.1016/j.ijcha.2023.101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
Background Multiple domains of quality of life (QoL) such as erectile function are not sufficiently investigated among left ventricular assist-device (LVAD) patients. We aimed to evaluate the prevalence of erectile dysfunction (ED) and its association with QoL and depression. Methods This is a prospective, single-center, cross-sectional study. We included adult male LVAD patients who were clinically stable after at least 3 months post-implantation. Erectile function was assessed with the International Index of Erectile Function (IIEF-5) questionnaire with a score of ≤21 being confirmatory for ED. QoL and depression were estimated with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Patient Health Questionnaire depression scale (PHQ-8), respectively. Results The study included 56 patients, of whom 45 (80 %) met criteria for ED, a prevalence much higher than previously reported in patients with established cardiovascular disease or conservatively treated heart failure. Patients with ED were older and had lower 6-minute walking distance. ED was not associated with comorbidities and heart failure medications but with less frequent use of diuretics and phosphodiesterase-5 inhibitors. There was a correlation between erectile function and depression as well as QoL. Conclusions These findings underscore that ED deserves special attention and should be included in a multi-targeted approach to address suboptimal QoL outcomes after LVAD implantation.
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Affiliation(s)
- Aiste Monika Jakstaite
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Simon Wernhart
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Markus Kamler
- Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic- and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Hahn EA, Allen LA, Lee CS, Denfeld QE, Stehlik J, Cella D, Lindenfeld J, Teuteberg JJ, McIlvennan CK, Kiernan MS, Beiser DG, Walsh MN, Adler ED, Ruo B, Kirklin JK, Klein L, Bedjeti K, Cummings PD, Burns JL, Vela AM, Grady KL. PROMIS: Physical, Mental and Social Health Outcomes Improve From Before to Early After LVAD Implant: Findings From the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) Study. J Card Fail 2023; 29:1398-1411. [PMID: 37004864 PMCID: PMC10544687 DOI: 10.1016/j.cardfail.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/28/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
Study participants (n = 272) completed 12 Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental and social health measures (questionnaires) prior to implantation of a left ventricular assist device (LVAD) and again at 3 and 6 months postimplant. All but 1 PROMIS measure demonstrated significant improvement from pre-implant to 3 months; there was little change between 3 and 6 months. Because PROMIS measures were developed in the general population, patients with an LVAD, their caregivers and their clinicians can interpret the meaning of PROMIS scores in relation to the general population, helping them to monitor a return to normalcy in everyday life.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Larry A Allen
- Department of Cardiology, University of Colorado, Aurora, CO
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, Portland, OR
| | - Josef Stehlik
- Department of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - David G Beiser
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mary N Walsh
- Ascension St. Vincent Heart Center, Indianapolis, IN
| | - Eric D Adler
- Department of Medicine, University of California, San Diego, CA
| | - Bernice Ruo
- Department of Medicine, University of California, San Diego, CA
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Liviu Klein
- Department of Medicine, University of California, San Francisco, CA
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter D Cummings
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alyssa M Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L Grady
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kilic A, Kwon JH, Grady KL, Singletary BA, Kilic A, Everitt M, Cleveland J, Cantor RS, Blackmon S, Breathett K, McKellar S, Keebler M, Kirklin JK, Stehlik J. Impact of adverse events on health-related quality of life after left ventricular assist device implantation: An STS INTERMACS analysis. J Heart Lung Transplant 2023; 42:1214-1222. [PMID: 37040860 DOI: 10.1016/j.healun.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND We sought to quantify the impact of pre- and postoperative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation. METHODS Primary durable LVAD implants between 2012 and 2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and postimplant adverse events (AEs) on HRQOL as assessed by the EQ-5D visual analog scale (VAS) and the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) at 6 months and 3 years. RESULTS Of 22,230 patients, 9,888 had VAS and 10,552 had KCCQ reported at 6 months, and 2,170 patients had VAS and 2,355 had KCCQ reported at 3 years postimplant. VAS improved from a mean of 38.2 ± 28.3 to 70.7 ± 22.9 at 6 months and from 40.1 ± 27.8 to 70.3 ± 23.1 at 3 years. KCCQ improved from 28.2 ± 23.9 to 64.3 ± 23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ± 23.7 at 3 years. Preimplant variables, including baseline VAS, had small effect sizes on HRQOL while postimplant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years. CONCLUSIONS AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.
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Affiliation(s)
- Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Jennie H Kwon
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kathleen L Grady
- Departments of Surgery and Medicine. Northwestern University, Chicago, Illinois
| | - Brandon A Singletary
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Melanie Everitt
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Joseph Cleveland
- Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shanda Blackmon
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Stephen McKellar
- Division of Cardiovascular and Thoracic Surgery, Intermountain Medical Center, Murray, Utah
| | - Mary Keebler
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
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8
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Okwuosa IS, Anderson A, Petty M, Wu T, Andrei AC, Kao A, Spertus JA, Pham DT, Yancy CW, Dew MA, Hsich E, Cotts W, Hartupee J, Pamboukian S, Pagani F, Lampert B, Johnson M, Murray M, Tekeda K, Yuzefpolskaya M, Kirklin JK, Grady KL. Caregiver burden before heart transplantation and long-term mechanical circulatory support: Findings from the sustaining quality of life of the aged: Transplant or mechanical support (SUSTAIN-IT) study. J Heart Lung Transplant 2023; 42:1197-1204. [PMID: 37088337 DOI: 10.1016/j.healun.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Caregiving for heart failure (HF) patients is burdensome. We examined differences in caregiver burden for 3 groups of older advanced HF patients: (1) supported with mechanical circulatory support (MCS) before heart transplantation (HT MCS), (2) awaiting transplant without MCS (HT non-MCS), and (3) prior to long-term MCS and factors associated with burden. METHOD From October 1, 2015 to December 31, 2018, we enrolled 276 caregivers for HF patients from 13 U.S. sites: 85 HT MCS, 96 HT non-MCS, and 95 prior to long-term MCS. At enrollment, caregivers completed the Oberst Caregiving Burden Scale (15 items, 2 subscales: time (range = 1-5; higher score = more time spent on task) and difficulty (range = 1-5; higher score = higher difficulty of task) and other measures. Statistical analyses included descriptive statistics, ANOVA, chi-square tests, and linear regression. RESULT Overall, caregivers were aged 60.8 ± 9.8 years and predominantly white, female, spouses, well educated, and reported ≥1 comorbidities. Caregivers overall reported a moderate amount of time spent on tasks and slight task difficulty. Caregivers for HT non-MCS candidates reported significantly less perceived time spent on tasks than caregivers for HT MCS candidates and caregivers for patients prior to long-term MCS (2.2 ± 0.74 vs 2.4 ± 0.74 vs 2.5 ± 0.71, respectively, p = 0.02) and less perceived difficulty of tasks (1.2 ± 0.33 vs 1.4 ± 0.53 vs 1.4 ± 0.54, respectively, p = 0.01). Caregiver and patient factors were associated with caregiver burden. CONCLUSIONS Prior to HT and long-term MCS, caregiver burden was low to moderate. Caregiver factors were predominantly associated with caregiver burden. Understanding caregiver burden and factors affecting caregiver burden may enhance preoperative advanced therapies discussions and guide caregiver support.
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Affiliation(s)
- Ike S Okwuosa
- Northwestern University Feinberg, School of Medicine, Division of Cardiology, Chicago, Illinois.
| | - Allen Anderson
- Northwestern University Feinberg, School of Medicine, Division of Cardiology, Chicago, Illinois
| | - Michael Petty
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Tingqing Wu
- Northwestern University Feinberg, School of Medicine, Division of Cardiology, Chicago, Illinois
| | | | - Andrew Kao
- Cardiovascular Disease, Advanced Heart Failure and Transplant Cardiology, Kansas City, Missouri
| | - John A Spertus
- Washington University in St Louis, Division of Cardiology, St. Louis, Missouri
| | - Duc T Pham
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Clyde W Yancy
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
| | - Eileen Hsich
- Cleveland Clinic Foundation, Division of Cardiovascular Medicine, Cleveland, Ohio
| | - William Cotts
- Advocate Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Justin Hartupee
- Washington University in St Louis, Division of Cardiovascular Medicine, St. Louis, Missouri
| | - Salpy Pamboukian
- Department of Medicine, Division of Cardiovascular Disease, Birmingham, Albama
| | - Francis Pagani
- University of Michigan, Division of Cardiac Surgery, Ann Arbor, Michigan
| | - Brent Lampert
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus, Ohio
| | - Maryl Johnson
- University of Wisconsin, Division of Cardiovascular Medicine, Madison, Wisconsin
| | - Margaret Murray
- University of Wisconsin, Division of Cardiothoracic Surgery, Madison, Wisconsin
| | - Koji Tekeda
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - James K Kirklin
- University of Alabama, Birmingham, Department of Surgery, Division of Cardiothoracic Surgery, Birmingham, Alabama
| | - Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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9
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Chuzi S, Wilcox JE, Kao A, Spertus JA, Hsich E, Dew MA, Yancy CW, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Wu T, Andrei AC, Baldridge A, Grady KL. Change in Caregiver Health-Related Quality of Life From Before to Early After Surgery: SUSTAIN-IT Study. Circ Heart Fail 2023; 16:e010038. [PMID: 37345518 PMCID: PMC10482357 DOI: 10.1161/circheartfailure.122.010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Information about health-related quality of life (HRQOL) among caregivers of older patients with heart failure who receive heart transplantation (HT) and mechanical circulatory support (MCS) is sparse. We describe differences and factors associated with change in HRQOL before and early post-surgery among caregivers of older heart failure patients who underwent 3 surgical therapies: HT with pretransplant MCS (HT MCS), HT without pretransplant MCS (HT non-MCS), and long-term MCS. METHODS Caregivers of older patients (60-80 years) from 13 US sites completed the EQ-5D-3 L visual analog scale (0 [worst]-100 [best] imaginable health state) and dimensions before and 3 and 6 months post-surgery. Analyses included linear regression, t tests, and nonparametric tests. RESULTS Among 227 caregivers (HT MCS=54, HT non-MCS=76, long-term MCS=97; median age 62.7 years, 30% male, 84% White, 83% spouse/partner), EQ-5D visual analog scale scores were high before (84.8±14.1) and at 3 (84.7±13.0) and 6 (83.9±14.7) months post-surgery, without significant differences among groups or changes over time. Patient pulmonary hypertension presurgery (β=-13.72 [95% CI, -21.07 to -6.36]; P<0.001) and arrhythmia from 3 to 6 months post-operatively (β=-14.22 [95% CI, -27.41 to -1.02]; P=0.035) were associated with the largest decrements in caregiver HRQOL; patient marital/partner status (β=6.21 [95% CI, 1.34-11.08]; P=0.013) and presurgery coronary disease (β=8.98 [95% CI, 4.07-13.89]; P<0.001) were associated with the largest improvements. CONCLUSIONS Caregivers of older patients undergoing heart failure surgeries reported overall high HRQOL before and early post-surgery. Understanding factors associated with caregiver HRQOL may inform decision-making and support needs. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02568930.
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Affiliation(s)
| | | | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO
| | | | | | | | | | | | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis, MN
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10
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Asase M, Watanabe T, Takegami M, Nishimura K, Nin K, Fukushima N. Impact of Different Therapeutic Strategies With Left Ventricular Assist Devices on Health-Related Quality of Life During Prolonged Device-Based Support. Circ Rep 2023; 5:289-297. [PMID: 37431516 PMCID: PMC10329900 DOI: 10.1253/circrep.cr-22-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/19/2023] [Accepted: 04/16/2023] [Indexed: 07/12/2023] Open
Abstract
Background: Left ventricular assist device (LVAD) implantation improves survival and health-related quality of life (HRQoL) of patients with heart failure. However, the impact of LVADs or different LVAD-based therapeutic strategies on long-term HRQoL has not been investigated. We evaluated the long-term HRQoL of Japanese patients who were treated with different LVAD-based therapeutic strategies. Methods and Results: Patients whose data were recorded in the Japanese Registry for Mechanical Assisted Circulatory Support between January 2010 and December 2018 were divided into 3 groups: primary implantable LVAD (G-iLVAD; n=483), primary paracorporeal LVAD (n=33), and bridge-to-bridge from paracorporeal to implantable LVAD (n=65). HRQoL was evaluated using the EuroQoL 5-dimension 3-level (EQ-5D-3L) before and 3 and 12 months after LVAD implantation; the mean EQ-5D-3L visual analog scale (VAS) score in the G-iLVAD group at these time points was 47.4, 71.1, and 72.9, respectively (where scores of 0 and 100 indicate worst and best imaginable health state, respectively). Changes in the least squares means of the VAS scores at 3 and 12 months after implantation differed significantly among the 3 groups. Social function, disability, and physical and mental problems were significantly lower in the G-iLVAD than other groups. Conclusions: HRQoL improved significantly at 3 and 12 months after LVAD implantation in all groups. Physical function showed a stronger improvement than did social function, disability, and mental function.
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Affiliation(s)
- Mariko Asase
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University Kyoto Japan
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Suita Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Suita Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center Suita Japan
- Faculty of Nursing, Graduate School of Nursing, Senri Kinran University Suita Japan
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11
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Shetty NS, Parcha V, Abdelmessih P, Patel N, Hasnie AA, Kalra R, Pandey A, Breathett K, Morris AA, Arora G, Arora P. Sex-Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights From Interagency Registry for Mechanically Assisted Circulatory Support. Circ Heart Fail 2023; 16:e010189. [PMID: 37232167 PMCID: PMC10421565 DOI: 10.1161/circheartfailure.122.010189] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/20/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sex-associated differences in clinical outcomes among left ventricular assist device recipients in the United States have been recognized. However, an investigation of the social and clinical determinants of sex-associated differences is lacking. METHODS Left ventricular assist device receiving patients enrolled in Interagency Registry for Mechanically Assisted Circulatory Support between 2005 and 2017 were included. The primary outcome was all-cause mortality. Secondary outcomes included heart transplantation and postimplantation adverse event rates. The cohort was stratified by the social subgroup of race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic), and clinical subgroups of device strategy (destination therapy, bridge to transplant, and bridge to candidacy), and implantation center volume (low [≤20 implants/y], medium [21-30 implants/y], and high [>30 implants/y]). A multivariable-adjusted Cox proportional hazard model was used to assess the risk of death and heart transplantation with prespecified interaction testing. Poisson regression was used to estimate adverse events by sex across the various subgroups. RESULTS Among 18 525 patients, there were 3968 (21.4%) females. Compared with their male counterparts, Hispanic (adjusted hazard ratio [HRadj], 1.75 [1.23-2.47]) females had the highest risk of death followed by non-Hispanic White females (HRadj, 1.15 [1.07-1.25]; Pinteraction=0.02). Hispanic (HRadj, 0.60 [0.40-0.89]) females had the lowest cumulative incidence of heart transplantation followed by non-Hispanic Black females (HRadj, 0.76 [0.67-0.86]), and non-Hispanic White females (HRadj, 0.88 [0.80-0.96]) compared with their male counterparts (Pinteraction<0.001). Compared with their male counterparts, females on the bridge to candidacy strategy (HRadj, 1.32 [1.18-1.48]) had the highest risk of death (Pinteraction=0.01). The risk of death (Pinteraction=0.44) and cumulative incidence of heart transplantation (Pinteraction=0.40) did not vary by sex in the center volume subgroup. A higher incidence rate of adverse events after left ventricular assist device implantation was also seen in females compared with the males, overall, and across all subgroups. CONCLUSIONS Among left ventricular assist device recipients, the risk of death, the cumulative incidence of heart transplantation, and adverse events differ by sex across the social and clinical subgroups.
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Affiliation(s)
- Naman S. Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Abdelmessih
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammar A. Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Khadijah Breathett
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alanna A. Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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12
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Elderly Patients With Higher Acuity Have Similar Left Ventricular Assist Device Outcomes as Younger Patients at a Nontransplant Center. Am J Cardiol 2023; 189:93-97. [PMID: 36521414 DOI: 10.1016/j.amjcard.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
Although left ventricular assist device (LVAD) implantation is associated with acceptable survival, previous reports have demonstrated that advanced age is associated with increased short-term mortality. Because age is a relative contraindication to transplantation, nontransplant centers tend to implant a disproportionate number of elderly patients. We undertook this study to evaluate the impact of advanced age on LVAD outcomes at a nontransplant center. We conducted a retrospective review of all LVAD implants at our center from 2017 to 2022. Primary stratification was by age >70 years. The primary outcome was survival as assessed by the Kaplan-Meier method. The risk of 1-year mortality was further evaluated using multivariable Cox proportional hazards regression modeling. From 2017 to 2022, 93 patients underwent LVAD implantation. The mean age was 65.03 ± 11.28 years, with a median age of 68 (60 to 73) years. Most patients were INTERMACS 1 or 2 (71 patients; 76.34%). When stratified by age, 41 patients (44.09%) were aged ≥70 years. Patients aged ≥70 years had similar 30-day (96.15% vs 100.00%, p = 0.213), 1-year (90.05% vs 84.00%, p = 0.444), and 2-year survival (82.03% vs 84.00%, p = 0.870). When only the INTERMACS 1 and 2 patients with higher acuity were included, there was still no difference in 30-day, 1-year, or 2-year survival. On multivariable analysis, age >70 years was not associated with an increased hazard of 1-year mortality (0.90 [0.22 to 3.67], p = 0.878). In conclusion, in carefully selected patients, age >70 years is not associated with increased short-term mortality. Age alone should not be a contraindication to LVAD therapy.
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13
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Hahn EA, Walsh MN, Allen LA, Lee CS, Denfeld QE, Teuteberg JJ, Beiser DG, McIlvennan CK, Lindenfeld J, Klein L, Adler ED, Stehlik J, Ruo B, Bedjeti K, Cummings PD, Vela AM, Grady KL. Validity of Patient-Reported Outcomes Measurement Information System Physical, Mental, and Social Health Measures After Left Ventricular Assist Device Implantation and Implications for Patient Care. Circ Cardiovasc Qual Outcomes 2023; 16:e008690. [PMID: 36752104 PMCID: PMC9940833 DOI: 10.1161/circoutcomes.121.008690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND A better understanding is needed of the burdens and benefits of left ventricular assist device (LVAD) implantation on patients' physical, mental, and social well-being. The purpose of this report was to evaluate the validity of Patient-Reported Outcomes Measurement Information System (PROMIS) measures for LVAD patients and to estimate clinically important score differences likely to have implications for patient treatment or care. METHODS Adults from 12 sites across all US geographic regions completed PROMIS measures ≥3 months post-LVAD implantation. Other patient-reported outcomes (eg, Kansas City Cardiomyopathy Questionnaire-12 item), clinician ratings, performance tests, and clinical adverse events were used as validity indicators. Criterion and construct validity and clinically important differences were estimated with Pearson correlations, ANOVA methods, and Cohen d effect sizes. RESULTS Participants' (n=648) mean age was 58 years, and the majority were men (78%), non-Hispanic White people (68%), with dilated cardiomyopathy (55%), long-term implantation strategy (57%), and New York Heart Association classes I and II (54%). Most correlations between validity indicators and PROMIS measures were medium to large (≥0.3; p<0.01). Most validity analyses demonstrated medium-to-large effect sizes (≥0.5) and clinically important differences in mean PROMIS scores (up to 14.8 points). Ranges of minimally important differences for 4 PROMIS measures were as follows: fatigue (3-5 points), physical function (2-3), ability to participate in social roles and activities (3), and satisfaction with social roles and activities (3-5). CONCLUSIONS The findings provide convincing evidence for the relevance and validity of PROMIS physical, mental, and social health measures in patients from early-to-late post-LVAD implantation. Findings may inform shared decision-making when patients consider treatment options. Patients with an LVAD, their caregivers, and their clinicians should find it useful to interpret the meaning of their PROMIS scores in relation to the general population, that is, PROMIS may help to monitor a return to normalcy in everyday life.
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Affiliation(s)
- Elizabeth A. Hahn
- Medical Social Sciences (E.A.H., K.B., P.D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary N. Walsh
- Ascension St. Vincent Heart Center, Indianapolis, IN (M.N.W.)
| | - Larry A. Allen
- Cardiology, University of Colorado, Aurora (L.A.A., C.K.M.)
| | - Christopher S. Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA (C.S.L.)
| | - Quin E. Denfeld
- Oregon Health and Science University School of Nursing, Portland (Q.E.D.)
| | | | | | | | | | - Liviu Klein
- Medicine, University of California, San Francisco (L.K.)
| | - Eric D. Adler
- Medicine, University of California, San Diego (E.D.A., B.R.)
| | - Josef Stehlik
- Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City (J.S.)
| | - Bernice Ruo
- Medicine, University of California, San Diego (E.D.A., B.R.)
| | - Katy Bedjeti
- Medical Social Sciences (E.A.H., K.B., P.D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter D. Cummings
- Medical Social Sciences (E.A.H., K.B., P.D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alyssa M. Vela
- Surgery (A.M.V., K.L.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L. Grady
- Surgery (A.M.V., K.L.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
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14
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Grady KL, Kao A, Spertus JA, Hsich E, Dew MA, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Andrei AC, Elenbaas C, Baldridge A, Yancy C. Health-Related Quality of Life in Older Patients With Heart Failure From Before to Early After Advanced Surgical Therapies: Findings From the SUSTAIN-IT Study. Circ Heart Fail 2022; 15:e009579. [PMID: 36214123 PMCID: PMC9561242 DOI: 10.1161/circheartfailure.122.009579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Restoring health-related quality of life (HRQOL) is a therapeutic goal for older patients with advanced heart failure. We aimed to describe change in HRQOL in older patients (60–80 years) awaiting heart transplantation (HT) with or without pretransplant mechanical circulatory support (MCS) or scheduled for long-term MCS, if ineligible for HT, from before to 6 months after these surgeries and identify factors associated with change.
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Affiliation(s)
- Kathleen L. Grady
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO (A.K.)
| | | | | | | | - Duc-Thinh Pham
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis (M.P.)
| | | | | | | | | | | | | | - Koji Takeda
- Columbia University, New York, NY (K.T., M.Y.)
| | | | | | | | - Adin-Cristian Andrei
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Christian Elenbaas
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Abigail Baldridge
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Clyde Yancy
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
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15
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Time Spent Engaging in Health Care Among Patients With Left Ventricular Assist Devices. JACC. HEART FAILURE 2022; 10:321-332. [PMID: 35483794 PMCID: PMC9908068 DOI: 10.1016/j.jchf.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aims to examine a novel patient-centered metric of time spent engaging in left ventricular assist device (LVAD)-related clinical care outside the home. BACKGROUND Although LVAD implantation can improve survival and functional capacity in patients with advanced heart failure, this may occur at the expense of significant time spent engaging in LVAD-related health care activities. METHODS The authors retrospectively assessed consecutive patients at a single center who received a continuous-flow LVAD between May 9, 2008, and December 31, 2019, and queried health care encounters after implantation, including all inpatient encounters and LVAD-related ambulatory encounters. Patient-level time metrics were determined, including the total number of days with any health care encounter, and the total estimated time spent receiving care. The primary outcome was the proportion (%) of days alive with an LVAD spent engaged in at least 1 health care encounter. The secondary outcome was the proportion (%) of total time alive with an LVAD spent receiving care. RESULTS Among 373 patients, the median number of days alive with LVAD was 390 (IQR: 158-840 days). Patients had a median number of 88 (IQR: 45-161) days with ≥1 health care encounter, accounting for 23.2% (IQR: 16.3%-32.4%) of their days alive with an LVAD. A median 6.0% (IQR: 2.1%-14.1%) and 15.0% (IQR: 10.7%-20.0%) of total days alive were spent in inpatient and ambulatory encounters, respectively. Patients spent a median of 592 (IQR: 197-1,257) hours receiving care, accounting for 5.6% (IQR: 2.2%-12.7%) of their total time alive with an LVAD. CONCLUSIONS LVAD patients spent more than 1 of every 5 days engaging in health care. Our findings may inform strategies to improve efficiency of postdischarge care delivery and expectations for post-treatment care.
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16
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Grady KL, Andrei A, Elenbaas C, Warzecha A, Baldridge A, Kao A, Spertus JA, Pham D, Dew MA, Hsich E, Cotts W, Hartupee J, Pamboukian SV, Pagani FD, Petty M, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Yancy C. Health‐Related Quality of Life in Older Patients With Advanced Heart Failure: Findings From the SUSTAIN‐IT Study. J Am Heart Assoc 2022; 11:e024385. [PMID: 35156421 PMCID: PMC9245796 DOI: 10.1161/jaha.121.024385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is a paucity of research describing health‐related quality of life (HRQOL) in older adults considered for advanced heart failure surgical therapies. Using data from our SUSTAIN‐IT (Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support) study, we aimed to compare HRQOL among 3 groups of older (60–80 years) patients with heart failure before heart transplantation (HT) or long‐term mechanical circulatory support (MCS) and identify factors associated with HRQOL: (1) HT candidates with MCS, (2) HT candidates without MCS, or (3) candidates ineligible for HT and scheduled for long‐term MCS. Methods and Results Patients from 13 US sites completed assessments, including self‐reported measures of HRQOL (EuroQol‐5 Dimension Questionnaire, Kansas City Cardiomyopathy Questionnaire–12), depressive symptoms (Personal Health Questionnaire–8), anxiety (State‐Trait Anxiety Inventory–state form), cognitive status (Montreal Cognitive Assessment), and performance‐based measures (6‐minute walk test and 5‐m gait speed). Analyses included ANOVA, χ2 tests, Fisher’s exact tests, and linear regression. The sample included 393 patients; the majority of patients were White men and married. Long‐term MCS candidates (n=154) were significantly older and had more comorbidities and a higher New York Heart Association class than HT candidates with MCS (n=118) and HT candidates without MCS (n=121). Long‐term MCS candidates had worse HRQOL than HT candidates with and without MCS (EQ‐5D visual analog scale scores, 46±23 versus 68±18 versus 54±23 [P<0.001] and Kansas City Cardiomyopathy Questionnaire–12 overall summary scores, 35±21 versus 60±21 versus 49±22 [P<0.001], respectively). In multivariable analyses, lower 6‐minute walk distance, higher New York Heart Association class, depressive symptoms, and not being an HT candidate with MCS were significantly associated with worse overall HRQOL. Conclusions Our findings demonstrate important differences in overall and domain‐specific HRQOL of older patients with heart failure before HT or long‐term MCS. Understanding HRQOL differences may guide decisions toward more appropriate and personalized advanced heart failure therapies.
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Affiliation(s)
| | | | | | - Anna Warzecha
- Department of SurgeryNorthwestern UniversityChicagoIL
| | | | - Andrew Kao
- Department of MedicineSt. Luke’s Medical CenterKansas CityMO
| | - John A. Spertus
- Department of MedicineUniversity of Missouri‐Kansas CityKansas CityMO
| | | | - Mary Amanda Dew
- Department of PsychiatryUniversity of PittsburghPittsburghPA
| | - Eileen Hsich
- Department of Cardiovascular MedicineCleveland ClinicClevelandOH
| | - William Cotts
- Advocate Heart InstituteAdvocate Christ Medical CenterOak LawnIL
| | | | | | | | - Michael Petty
- Department of NursingUniversity of Minnesota Medical CenterMinneapolisMN
| | - Brent Lampert
- Department of Internal MedicineOhio State UniversityColumbusOH
| | - Maryl Johnson
- Department of MedicineUniversity of WisconsinMadisonWI
| | - Margaret Murray
- University of Wisconsin Hospitals and ClinicsUniversity of WisconsinMadisonWI
| | - Koji Takeda
- Department of SurgeryColumbia UniversityNew YorkNY
| | | | | | - James K. Kirklin
- Department of SurgeryUniversity of Alabama‐BirminghamBirminghamAL
| | - Clyde Yancy
- Department of MedicineNorthwestern UniversityChicagoIL
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Patient and Caregiver Health-related Quality of Life and Caregiver Burden While Awaiting Heart Transplantation: Findings From the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support (SUSTAIN-IT) Study. Transplant Direct 2021; 7:e796. [PMID: 34841048 PMCID: PMC8613352 DOI: 10.1097/txd.0000000000001249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background We sought to compare change over time (baseline to 2 y) in health-related quality of life (HRQOL) between older (60-80 y) patients awaiting heart transplantation (HT) with mechanical circulatory support (MCS) versus without MCS and their caregivers and caregiver burden. Methods This study was conducted at 13 United States sites. Patient HRQOL was examined using the EuroQol 5-dimensional questionnaire (EQ-5D-3L) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Caregiver measures included the EQ-5D-3L and Oberst Caregiving Burden Scale, measuring time on task and difficulty. Analyses included analysis of variance, χ2, and linear regression. Results We enrolled 239 HT candidates (n = 118 with MCS and n = 121 without MCS) and 193 caregivers (n = 92 for candidates with MCS and n = 101 for candidates without MCS). Baseline differences in HRQOL were observed between HT candidates with and without MCS: EQ-5D-3L visual analog scale (VAS) score (67.7 ± 17.6 versus 54.1 ± 23.3, P < 0.001) and KCCQ-12 overall summary score (59.9 ± 21.0 versus 48.9 ± 21.6, P < 0.001), respectively. HT candidates with MCS had significantly higher EQ-5D-3L VAS scores and KCCQ-12 overall summary score across time versus without MCS. Baseline EQ-5D-3L VAS scores did not differ significantly between caregivers of HT candidates with and without MCS (84.6 ± 12.9 versus 84.3 ± 14.4, P = 0.9), respectively, nor were there significant between-group differences over time. Caregivers for HT candidates with MCS reported more task difficulty (range: 1 = not difficult to 5 = extremely difficult) versus caregivers for those without MCS at baseline (1.4 ± 0.5 versus 1.2 ± 0.3, P = 0.004) and over time. Conclusions Understanding differences in HRQOL and caregiver burden among older HT candidates with and without MCS and their caregivers may inform strategies to enhance HRQOL and reduce burden.
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18
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Emerson D, Chikwe J, Catarino P, Hassanein M, Deng L, Cantor RS, Roach A, Cole R, Esmailian F, Kobashigawa J, Moriguchi J, Kirklin JK. Contemporary Left Ventricular Assist Device Outcomes in an Aging Population: An STS INTERMACS Analysis. J Am Coll Cardiol 2021; 78:883-894. [PMID: 34446160 DOI: 10.1016/j.jacc.2021.06.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Survival, functional outcomes, and quality of life after left ventricular assist device (LVAD) are ill-defined in elderly patients, and with new-generation devices. OBJECTIVES This study sought to evaluate survival, functional outcomes, and quality of life after LVAD in contemporary practice. METHODS Adults receiving durable LVADs between January 1, 2010, and March 1, 2020, were identified from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The primary outcome was adjusted survival; secondary outcomes included quality of life rated using a visual analogue scale (where 0 represents "worst health" and 100 "best health"); 6-minute walk distance; stroke; device malfunction; and rehospitalization, stratified by patient age. Median follow-up was 15 months (IQR: 6-32 months). RESULTS The cohort comprised 68.9% (n = 16,808) patients aged <65 years, 26.3% (n = 6,418) patients aged 65-75 years, and 4.8% (n = 1,182) patients aged >75 years, who were predominantly male (n = 19,119, 78%) and on destination therapy (n = 12,425, 51%). Competing outcomes analysis demonstrated mortality (70% CIs) of 34% (33%-34%), 54% (54%-55%), and 66% (64%-68%) for patients aged <65, 65-75, and >75 years, respectively, which improved during the study in patients aged >75 years. Newer-generation devices were associated with reduced late mortality (HR: 0.35; 95% CI: 0.25-0.49). Stroke, device malfunction or thrombosis, and rehospitalizations decreased with increasing age (all P < 0.01). Median 6-minute walk distance increased from 0 feet (IQR: 0-665 feet) to 1,065 feet (IQR: 642-1,313 feet) (P < 0.001), and quality of life improved from 40 (IQR: 15-60) to 75 (IQR: 60-90) (P < 0.001) after LVAD in all age groups. CONCLUSIONS In elderly patients, LVADs are associated with increased functional capacity, similar improvements in quality of life, and fewer complications compared with younger patients.
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Affiliation(s)
- Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA.
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Mohamed Hassanein
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Luqin Deng
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Robert Cole
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jon Kobashigawa
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jaime Moriguchi
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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19
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Chuzi S, Ogunseitan A, Cameron KA, Grady K, Schulze L, Wilcox JE. Perceptions of Bereaved Caregivers and Clinicians About End-of-Life Care for Patients With Destination Therapy Left Ventricular Assist Devices. J Am Heart Assoc 2021; 10:e020949. [PMID: 34308687 PMCID: PMC8475670 DOI: 10.1161/jaha.121.020949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Background Patients with left ventricular assist devices (LVADs) implanted as destination therapy may receive suboptimal preparation for and care at the end of life, but there is limited understanding of the reasons for these shortcomings. Exploring perceptions of individuals (caregivers and clinicians) who are closely involved in the end-of-life experience with patients with destination therapy LVADs can help identify key opportunities for improving care. Methods and Results We conducted semistructured qualitative interviews with 7 bereaved caregivers of patients with destination therapy LVADs and 10 interdisciplinary LVAD clinicians. Interviews explored perceptions of preparing for end of life, communicating about end of life, and providing and receiving end-of-life care, and were analyzed using a 2-step team-based inductive approach to coding and analysis. Six themes pertaining to end-of-life experiences were derived: (1) timing end-of-life discussions in the setting of unpredictable illness trajectories, (2) prioritizing end-of-life preparation and decision-making, (3) communicating uncertainty while providing support and hope, (4) lack of consensus on responsibility for end-of-life discussions, (5) perception of the LVAD team as invincible, and (6) divergent perceptions of LVAD withdrawal. Conclusions This study revealed 6 unique aspects of end-of-life care for patients with destination therapy LVADs as reported by clinicians and caregivers. Themes coalesced around communication, team-based care, and challenges unique to patients with LVADs at end of life. Programmatic changes may address some aspects, including training clinicians in LVAD-specific communication skills. Other aspects, such as standardizing the role of the palliative care team and developing practical interventions that enable timely advance care planning during LVAD care, will require multifaceted interventions.
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Affiliation(s)
- Sarah Chuzi
- Division of CardiologyDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Adeboye Ogunseitan
- Division of Hospital Medicine (Palliative Care)Department of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Kenzie A. Cameron
- Division of General Internal Medicine and GeriatricsDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Kathleen Grady
- Division of CardiologyDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Division of Cardiac SurgeryDepartment of SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Lauren Schulze
- Division of Cardiac SurgeryDepartment of SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Jane E. Wilcox
- Division of CardiologyDepartment of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
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20
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Levelink M, Brütt AL. Factors influencing health-related quality of life of patients with a left ventricular assist device: a systematic review and thematic synthesis. Eur J Cardiovasc Nurs 2021; 20:803-815. [PMID: 34263313 DOI: 10.1093/eurjcn/zvab056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 11/14/2022]
Abstract
AIMS Left ventricular assist devices (LVADs) are increasingly being used in the treatment of advanced heart failure. Left ventricular assist device patients frequently report improvements in health-related quality of life (HRQOL) post-implantation. However, HRQOL varies over time and between patients, which can be explained by patient-related and environmental factors, as individual studies suggest. This review aims to synthesize qualitative evidence on factors influencing HRQOL of LVAD patients. METHODS AND RESULTS We systematically searched the databases PubMed, Scopus, PsycINFO, and CINAHL for qualitative studies on factors influencing HRQOL of patients with continuous flow LVADs. The included papers were synthesized using a thematic synthesis. The results were validated in discussion with a patient and practical implications were jointly developed. We included 11 papers and developed 7 themes that represent influencing factors for HRQOL of LVAD patients: disease experiences, emotional reactivity, heart failure and mechanical circulatory support symptoms, medical care, self-care, self-concept, and social environment. CONCLUSION The identified themes highlight influencing factors on HRQOL. These help to explain variation in patient outcomes and to better consider the individual situation in rehabilitation. Based on the results, four strategies are proposed for promoting psychosocial outcomes: facilitate self-care, ensure social support, offer psychosocial support, and manage patient expectations.
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Affiliation(s)
- Michael Levelink
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, School of Medicine and Health Sciences, Ammerländer Heerstr. 114-118, Oldenburg 26129, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, School of Medicine and Health Sciences, Ammerländer Heerstr. 114-118, Oldenburg 26129, Germany
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21
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Grady KL, Fazeli PL, Kirklin JK, Pamboukian SV, White-Williams C. Factors Associated With Health-Related Quality of Life 2 Years After Left Ventricular Assist Device Implantation: Insights From INTERMACS. J Am Heart Assoc 2021; 10:e021196. [PMID: 34238018 PMCID: PMC8483481 DOI: 10.1161/jaha.121.021196] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Factors related to health‐related quality of life (HRQOL) 2 years after left ventricular assist device (LVAD) implantation are unknown. We sought to determine whether preimplant intended goal of LVAD therapy (heart transplant candidate [short‐term group], uncertain heart transplant candidate [uncertain group], and heart transplant ineligible [long‐term group]) and other variables were related to HRQOL 2 years after LVAD implantation. Methods and Results Our LVAD sample (n=1620) was from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Using the EuroQol‐5 Dimension Questionnaire (EQ‐5D‐3L), a generic HRQOL measure, and the Kansas City Cardiomyopathy Questionnaire (KCCQ‐12), a heart failure–specific HRQOL measure, multivariable linear regression modeling was conducted with the EQ‐5D‐3L Visual Analog Scale (VAS) score and KCCQ‐12 overall summary score (OSS) as separate dependent variables. Two years after LVAD implant, the short‐term group had a significantly higher mean VAS score versus the uncertain and long‐term groups (short‐term: 75.18 [SD, 20.62]; uncertain: 72.27 [SD, 20.33]; long‐term: 70.87 [SD, 22.09], P=0.01); differences were not clinically meaningful. Two‐year mean scores did not differ by group for the KCCQ‐12 OSS (short‐term, 67.85 [SD, 20.61]; uncertain, 67.79 [SD, 19.31]; long‐term, 67.08 [SD, 21.49], P=0.80). Factors associated with a worse VAS score 2 years postoperatively (n=1205) included not working; not having a short‐term LVAD; and postoperative neurological dysfunction, greater health‐related stress, coping poorly, less VAD self‐care confidence, and less satisfaction with VAD surgery, explaining 28% of variance (P<0.001). Factors associated with a worse KCCQ‐12 OSS 2 years postoperatively (n=1250) included not working; history of high body mass index and diabetes mellitus; and postoperative renal dysfunction, greater health‐related stress, coping poorly, less VAD self‐care confidence, less satisfaction with VAD surgery, and regret regarding VAD implantation, accounting for 36% of variance (P<0.001). Conclusions Factors related to HRQOL 2 years after LVAD implantation include demographic, clinical, and psychological variables.
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Affiliation(s)
| | - Pariya L Fazeli
- Department of Family, Community, and Health Systems University of Alabama at Birmingham School of Nursing Birmingham AL
| | - James K Kirklin
- Department of Surgery University of Alabama at Birmingham Birmingham AL
| | - Salpy V Pamboukian
- Department of Surgery University of Alabama at Birmingham Birmingham AL.,Department of Medicine University of Alabama at Birmingham Birmingham AL
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22
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Itzhaki Ben Zadok O, Ben-Avraham B, Jaarsma T, Shaul A, Hammer Y, Barac YD, Mats I, Eldar O, Abuhazira M, Yaari V, Gulobov D, Mulu M, Aravot D, Kornowski R, Ben-Gal T. Health-related quality of life in left ventricular assist device-supported patients. ESC Heart Fail 2021; 8:2036-2044. [PMID: 33773095 PMCID: PMC8120365 DOI: 10.1002/ehf2.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
Aims This study aimed to evaluate the different health‐related quality of life (HR‐QoL) aspects in patients with both short‐term and long‐term duration LVAD support at pre‐specified time intervals. Methods and results We performed a single‐centre HR‐QoL analysis of short‐term and long‐term LVAD‐supported patients using the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ‐12) and the Changes in Sexual Functioning Questionnaire along with a survey to evaluate patients' social and driving routines. Data were collected at baseline and at 6 or 12 month follow‐up. Included were 46 patients with a median time from LVAD implantation of 1.1 [inter‐quartile range (IQR) 0.5, 2.6] years. The median KCCQ‐12 summary score was 56 (IQR 29, 74) with most favourable scores in the symptom frequency domain [75 (IQR 50, 92)] and worse scores in the physical limitation [42 (IQR 25, 75)] and QoL [44 (IQR 25, 75)] domains. No significant changes were apparent during study follow‐up [KCCQ‐12 summary score 56 (IQR 35, 80)], and no significant correlation between the KCCQ‐12 summary score and ventricular assist device‐support duration was detected (r = −0.036, P = 0.812). Sexual dysfunction was noted across all domains with a cumulative score of 31 (IQR 22, 42). Seventy‐six per cent of patients resumed driving after LVAD implantation, and 43% of patients reported they socialize with family and friends more frequently since surgery. Conclusions Short‐term and long‐term LVAD‐supported patients had impaired HR‐QoL and sexual function at baseline and at follow‐up yet reported an improvement in social interactions and independency. A broader spectrum of patient's reported HR‐QoL measures should be integrated into the pre‐LVAD implantation assessment and preparation.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben-Avraham
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tiny Jaarsma
- Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Medicine, Health and Care, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Aviv Shaul
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Hammer
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron D Barac
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Israel Mats
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Eldar
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel
| | - Miriam Abuhazira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Vicky Yaari
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dmitry Gulobov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Mastwal Mulu
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel
| | - Dan Aravot
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Stawiarski K, Ramakrishna H. Left Ventricular Mechanical Circulatory Support-Assessing Outcomes With New Data. J Cardiothorac Vasc Anesth 2020; 35:2499-2502. [PMID: 32921615 DOI: 10.1053/j.jvca.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/11/2022]
Abstract
Ventricular assist devices continue to play a significant role in the surgical management of advanced heart failure. Left ventricular assist devices in particular have seen a rapid evolution in design, technology, implantation, and outcomes. This concise review focuses on the key data that have been published in the past 5 years that have demonstrated this rapid evolution in left-sided mechanical circulatory support from principally bridge to transplantation to destination therapy, with an increasing emphasis on quality-of-life measures and durability.
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Affiliation(s)
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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24
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McGuinty C, Leong D, Weiss A, MacIver J, Kaya E, Hurlburt L, Billia F, Ross H, Wentlandt K. Heart Failure: A Palliative Medicine Review of Disease, Therapies, and Medications With a Focus on Symptoms, Function, and Quality of Life. J Pain Symptom Manage 2020; 59:1127-1146.e1. [PMID: 31866489 DOI: 10.1016/j.jpainsymman.2019.12.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022]
Abstract
Despite significant advances in heart failure (HF) treatment, HF remains a progressive, extremely symptomatic, and terminal disease with a median survival of 2.1 years after diagnosis. HF often leads to a constellation of symptoms, including dyspnea, fatigue, depression, anxiety, insomnia, pain, and worsened cognitive function. Palliative care is an approach that improves the quality of life of patients and their caregivers facing the problems associated with life-threatening illness and therefore is well suited to support these patients. However, historically, palliative care has often focused on supporting patients with malignant disease, rather than a progressive chronic disease such as HF. Predicting mortality in patients with HF is challenging. The lack of obvious transition points in disease progression also raises challenges to primary care providers and specialists to know at what point to integrate palliative care during a patient's disease trajectory. Although therapies for HF often result in functional and symptomatic improvements including health-related quality of life (HRQL), some patients with HF do not demonstrate these benefits, including those patients with a preserved ejection fraction. Provision of palliative care for patients with HF requires an understanding of HF pathogenesis and common medications used for these patients, as well as an approach to balancing life-prolonging and HRQL care strategies. This review describes HF and current targeted therapies and their effects on symptoms, hospital admission rates, exercise performance, HRQL, and survival. Pharmacological interactions with and precautions related to commonly used palliative care medications are reviewed. The goal of this review is to equip palliative care clinicians with information to make evidence-based decisions while managing the balance between optimal disease management and patient quality of life.
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Affiliation(s)
- Caroline McGuinty
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Derek Leong
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Andrea Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane MacIver
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ebru Kaya
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Lindsay Hurlburt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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25
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Coping, Mood, Quality of Life, and Outcomes in Recipients of Left Ventricular Assist Devices: A Cluster Analysis. Psychosom Med 2020; 81:192-199. [PMID: 30625121 DOI: 10.1097/psy.0000000000000658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Left ventricular assist devices (LVADs) are increasingly used for temporary circulatory support until transplant or as destination therapy for patients with end-stage heart failure. Understanding patients' attitudes and resources is crucial to support them. METHODS Sixty-one LVAD recipients (55 [10] years, 10% women, 15% destination therapy) participating in cardiac rehabilitation (CR) postimplant underwent assessment of coping styles (Coping Orientation for Problem Experiences), quality of life (Medical Outcomes Study Short-Form 36, Minnesota Living with Heart Failure Questionnaire), and mood (Hospital Anxiety and Depression Scale). RESULTS Cluster analysis identified two homogeneous groups: C1 (n = 18) patients had higher anxiety (9.6 [5.0] versus 4.0 [2.7], p < .001), depression (10 [3.0] versus 4 [2.7], p < .001), and avoidant coping (29 [5.2] versus 21.2 [3.8], p < .001) scores and worse quality of life (Short-Form 36 of the Medical Outcomes Study Physical Component Scale 31 [5.3] versus 35.6 [6.9], p < .001; Mental Component Scale 34.3 [6.8] versus 50.3 [8], p < .001; MLHFQ physical 26 [7.2] versus 13.9 [8.2], p < .001; emotional 17.7 [3.4] versus 3.86 [3.2], p < .001) than C2 participants (n = 43). During 31 (15-54) months, 20 patients (33%) died. By Cox multivariable analysis, after adjustment for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at surgery, and meters walked during 6 minutes at CR discharge, C1 was associated with mortality (hazard ratio = 2.858; 95% confidence interval = 1.102-7.408, p = .031; model χ = 7.286, df = 5, p = .20). Survival was 44% in C1 and 77% in C2 (log-rank p = .033). CONCLUSIONS Among patients discharged from CR after LVAD implant, one third show a profile characterized by worse perceived quality of life, mood disorders, and dysfunctional coping that is associated with long-term mortality, and these factors are potential targets for post-LVAD intensive support.
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26
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White-Williams C, Fazeli PL, Kirklin JK, Pamboukian SV, Grady KL. Differences in health-related quality of life by implant strategy: Analyses from the Interagency Registry for Mechanically Assisted Circulatory Support. J Heart Lung Transplant 2020; 39:62-73. [DOI: 10.1016/j.healun.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
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27
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Social Support Moderates the Relationship Between Perceived Stress and Quality of Life in Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2019; 33:E1-E9. [PMID: 29683872 DOI: 10.1097/jcn.0000000000000487] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Living with a left ventricular assist device has significant psychosocial sequelae that affect health-related quality of life (HRQOL). OBJECTIVE The purpose of this study was to (1) describe psychosocial indicators of stress including perceived stress, depression, fatigue, and coping; (2) examine relationships among stress indicators by level of perceived stress; (3) examine relationships among indicators of stress and clinical outcomes; and (4) test the moderation of social support on the relationship between stress and clinical outcomes. METHODS Participants were recruited from 2 outpatient clinics in a cross-sectional study design. Standardized measures were self-administered via survey. Descriptive statistics, correlation, and multiple linear regression analysis were conducted. RESULTS The sample (N = 62) was mostly male (78%), black (47%), and married (66%), with a mean age of 56.5 ± 13 years. The overall sample had a moderate stress profile: moderate perceived stress (mean, 11.7 ± 7), few depressive symptoms (mean, 3.2 ± 3.9), and moderate fatigue (mean, 14.3 ± 9.1). Increased perceived stress was associated with fatigue, depressive symptoms, and maladaptive coping (P < .001). Regression analysis demonstrated that perceived stress and fatigue were significant correlates of overall HRQOL (adj. R = 0.41, P < .0001). Social support moderated the relationship between perceived stress and HRQOL, controlling for fatigue (R = 0.49, P < .001). CONCLUSIONS Individuals living with left ventricular assist device with high perceived stress have worse depressive symptoms, fatigue, and coping. The influence of high social support to improve the relationship between stress and HRQOL underscores the importance of a comprehensive plan to address psychosocial factors.
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28
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Stahl EP, Dickert NW, Cole RT, Laskar SR, Morris AA, Smith AL, Vega JD, Gupta D. Decisional regret in left ventricular assist device patient-caregiver dyads. Heart Lung 2019; 48:400-404. [DOI: 10.1016/j.hrtlng.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 01/11/2023]
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29
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Voltolini A, Salvato G, Frigerio M, Cipriani M, Perna E, Pisu M, Mazza U. Psychological outcomes of left ventricular assist device long‐term treatment: A 2‐year follow‐up study. Artif Organs 2019; 44:67-71. [DOI: 10.1111/aor.13531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Alessandra Voltolini
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Gerardo Salvato
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
- Department of Brain and Brain and Behavioral Sciences University of Pavia Pavia Italy
- Cognitive Neuropsychology Centre ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
- NeuroMi Milan Center for Neuroscience Milan Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Manlio Cipriani
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Enrico Perna
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Mirella Pisu
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Umberto Mazza
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
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Lee CS, Gelow JM, Chien CV, Hiatt SO, Bidwell JT, Denfeld QE, Grady KL, Mudd JO. Implant Strategy-Specific Changes in Symptoms in Response to Left Ventricular Assist Devices. J Cardiovasc Nurs 2019; 33:144-151. [PMID: 28591005 DOI: 10.1097/jcn.0000000000000430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although we know that the quality of life generally improves after left ventricular assist device (LVAD) implantation, we know little about how symptoms change in response to LVAD. METHODS The purpose of this study was to compare the changes in symptoms between bridge and destination therapy patients as part of a prospective cohort study. Physical (dyspnea and wake disturbances) and affective symptoms (depression and anxiety) were measured before LVAD and at 1, 3, and 6 months after LVAD. Multiphase growth modeling was used to capture the 2 major phases of change: initial improvements between preimplant and 1 month after LVAD and subsequent improvements between 1 and 6 months after LVAD. RESULTS The sample included 64 bridge and 22 destination therapy patients as the preimplant strategy. Destination patients had worse preimplant dyspnea and wake disturbances, and they experienced greater initial improvements in these symptoms compared with bridge patients (all P < .05); subsequent change in both symptoms were similar between groups (both P > .05). Destination patients had worse preimplant depression (P = .042) but experienced similar initial and subsequent improvements in depression in response to LVAD compared with bridge patients (both P > .05). Destination patients had similar preimplant anxiety (P = .279) but experienced less initial and greater subsequent improvements in anxiety after LVAD compared with bridge patients (both P < .05). CONCLUSION There are many differences in the magnitude and timing of change in symptom responses to LVAD between bridge and destination therapy patients. Detailed information on changes in specific symptoms may better inform shared decision-making regarding LVAD.
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Affiliation(s)
- Christopher S Lee
- Christopher S. Lee, PhD, RN, FAHA, FAAN, FHFSA Carol A. Lindeman Distinguished Professor, School of Nursing and Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Jill M. Gelow, MD, MPH Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Christopher V. Chien, MD Assistant Professor, REX Healthcare, University of North Carolina, Raleigh. Shirin O. Hiatt, MPH, MS, RN Project Coordinator, School of Nursing, Oregon Health & Science University, Portland. Julie T. Bidwell, PhD, RN Post-doctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Quin E. Denfeld, PhD, RN Post-doctoral Fellow, Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Kathleen L. Grady, PhD, RN, FAHA, FAAN, FHFSA Professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. James O. Mudd, MD Associate Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland
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Tosto C, Adamo L, Craddock H, Di Blasi M, Girgenti R, Clemenza F, Carney RM, Ewald G. Relationship between device acceptance and patient-reported outcomes in Left Ventricular Assist Device (LVAD) recipients. Sci Rep 2019; 9:10778. [PMID: 31346241 PMCID: PMC6658659 DOI: 10.1038/s41598-019-47324-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
The number of Left Ventricular Assist Devices (LVADs) implanted each year is rising. Nevertheless, there are minimal data on device acceptance after LVAD implant, and on its relationship with patient-reported outcomes. We designed a cross-sectional study to address this knowledge gap and test the hypothesis that low device acceptance is associated with poorer quality of life, depression and anxiety. Self-report questionnaires were administered to assess quality of life (12-item Kansas City Cardiomyopathy Questionnaire quality of life subscale), level of anxiety (7-item Generalized Anxiety Disorder; GAD-7), level of depression (9-item Patient Health Questionnaire; PHQ-9) and device acceptance (Florida Patient Acceptance Survey; FPAS) to 101 consecutive patients presenting to LVAD clinic. Regression analysis showed a strong correlation between device acceptance and both psychological distress (p < 0.001) and quality of life (p < 0.001). Analysis of the sub-scales of the FPAS showed that patients had significant body image concerns, but return to function and device-related distress were the main drivers of the observed correlation between device acceptance and patient well-being. Younger age was associated with lower device acceptance (r = 0.36, p < 0.001) and lower quality of life (r = 0.54, p < 0.001). These findings suggest that interventions targeting device acceptance should be explored to improve outcomes in LVAD recipients.
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Affiliation(s)
- Crispino Tosto
- From the University of Palermo, Department of Psychological and Educational Sciences, Palermo, Italy
| | - Luigi Adamo
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Heidi Craddock
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Di Blasi
- From the University of Palermo, Department of Psychological and Educational Sciences, Palermo, Italy
| | | | | | - Robert M Carney
- From the Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Gregory Ewald
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Chuzi S, Grady KL, Ogunseitan A, Szmuilowicz E, Wilcox JE. Authors' Response. J Pain Symptom Manage 2019; 57:e11-e12. [PMID: 30552959 DOI: 10.1016/j.jpainsymman.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Kathleen L Grady
- Department of Medicine, Division of Cardiology, Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adeboye Ogunseitan
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eytan Szmuilowicz
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Mortality in status 2 patients listed for heart transplantation in the United States: Will understanding cause of death help justify implantation of left ventricular assist devices into less sick patients? Int J Cardiol 2019; 276:185-190. [DOI: 10.1016/j.ijcard.2018.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/30/2018] [Accepted: 11/06/2018] [Indexed: 11/23/2022]
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Magasi S, Buono S, Yancy CW, Ramirez RD, Grady KL. Preparedness and Mutuality Affect Quality of Life for Patients With Mechanical Circulatory Support and Their Caregivers. Circ Cardiovasc Qual Outcomes 2019; 12:e004414. [DOI: 10.1161/circoutcomes.117.004414] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susan Magasi
- Department of Occupational Therapy and Department of Disability Studies, University of Illinois at Chicago (S.M.)
| | - Sarah Buono
- Department of Medical Social Sciences (S.B.), Northwestern University, Chicago, IL
| | - Clyde W. Yancy
- Division of Cardiology, Department of Medicine and Department of Medical Social Sciences (C.W.Y.), Northwestern University, Chicago, IL
| | - Ricardo D. Ramirez
- Department of Occupational Therapy, University of Illinois at Chicago (R.D.R.)
| | - Kathleen L. Grady
- Division of Cardiac Surgery, Department of Surgery and Department of Medicine, Feinberg School of Medicine (K.L.G.), Northwestern University, Chicago, IL
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Chuzi S, Hale S, Arnold J, Zhou A, Harap R, Grady KL, Rich JD, Yancy CW, Ogunseitan A, Szmuilowicz E, Wilcox JE. Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis. J Pain Symptom Manage 2019; 57:100-107. [PMID: 30315917 DOI: 10.1016/j.jpainsymman.2018.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of "palliative care assessment" and preparedness planning. RESULTS Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning-device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities-were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. CONCLUSIONS One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
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Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Sarah Hale
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason Arnold
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy Zhou
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Harap
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathleen L Grady
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan D Rich
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Clyde W Yancy
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adeboye Ogunseitan
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eytan Szmuilowicz
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Rossi Ferrario S, Bacich D, Beltrame L, Balestroni G, Pistono M. Does a Comprehensive Inpatient Rehabilitation Program Improve Patients' and Caregivers' Emotional State in LVAD Patients? Artif Organs 2018; 43:229-233. [PMID: 30159914 DOI: 10.1111/aor.13351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 06/16/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022]
Abstract
Few studies evaluated the effect of cardiac rehabilitation programs on perceived emotional and health status of left ventricular assist device (LVAD) patients, and none explored their effect on caregivers' strain. We enrolled 119 adult LVAD patients, together with their caregivers (n = 91), in two Rehabilitation Institutes that provided inpatient multidisciplinary activities. At admittance and prior to discharge they completed questionnaires evaluating patient emotional state and subjective perception of health status, caregiver strain, and patient and caregiver perception of the VAD. Six months after discharge, patients and caregivers were contacted again and asked specific questions about their quality of life. Patients' state anxiety and depression symptoms significantly diminished at discharge (0.000), whereas their perception of general health status rose (0.000). Caregivers' perceived strain also significantly decreased (0.001) and the perceived device management skill grew both for patients and caregivers (0.000). A substantial amount (36%) of psychologically frail patients and caregivers, although improving their emotional condition, never reached that of the less frail subjects. At the 6-month follow-up, both patients and caregivers appeared stable in evaluating respectively their general health and their caregiving-related strain, compared to discharge. Our data show that a comprehensive inpatient rehabilitation program improves the emotional state of LVAD patients and of their caregivers, even in psychologically frailer subjects. Team approach makes patients and caregivers self-confident about device management, increasing their knowledge, clarifying their doubts, and encouraging them to handle the difficulties met during the rehabilitation period, suggesting strategies to cope with daily life at home.
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Affiliation(s)
- Silvia Rossi Ferrario
- Psychology-Neuropsychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Daniela Bacich
- Cardiolology Unit, Madonna della Salute Hospital, Porto Viro, RO, Italy
| | - Laura Beltrame
- Cardiolology Unit, Madonna della Salute Hospital, Porto Viro, RO, Italy
| | - Gianluigi Balestroni
- Psychology-Neuropsychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Massimo Pistono
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
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Grady KL, Jones PG, Cristian-Andrei A, Naftel DC, Myers S, Dew MA, Idrissi K, Weidner G, Wissman SA, Kirklin JK, Spertus JA. Causes and Consequences of Missing Health-Related Quality of Life Assessments in Patients Who Undergo Mechanical Circulatory Support Implantation: Insights From INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Circ Cardiovasc Qual Outcomes 2018; 10:e003268. [PMID: 29246883 DOI: 10.1161/circoutcomes.116.003268] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/30/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Missing health-related quality of life (HRQOL) data in longitudinal studies can reduce precision and power and bias results. Using INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support), we sought to identify factors associated with missing HRQOL data, examine the impact of these factors on estimated HRQOL assuming missing at random missingness, and perform sensitivity analyses to examine missing not at random (MNAR) missingness because of illness severity. METHODS AND RESULTS INTERMACS patients (n=3248) with a preimplantation profile of 1 (critical cardiogenic shock) or 2 (progressive decline) were assessed with the EQ-5D-3L visual analog scale and Kansas City Cardiomyopathy Questionnaire-12 summary scores pre-implantation and 3 months postoperatively. Mean and median observed and missing at random-imputed HRQOL scores were calculated, followed by sensitivity analyses. Independent factors associated with HRQOL scores and missing HRQOL assessments were determined using multivariable regression. Independent factors associated with preimplantation and 3-month HRQOL scores, and with the likelihood of missing HRQOL assessments, revealed few correlates of HRQOL and missing assessments (R2 range, 4.7%-11.9%). For patients with INTERMACS profiles 1 and 2 and INTERMACS profile 1 alone, missing at random-imputed mean and median HRQOL scores were similar to observed scores, before and 3 months after implantation, whereas MNAR-imputed mean scores were lower (≥5 points) at baseline but not at 3 months. CONCLUSIONS We recommend use of sensitivity analyses using an MNAR imputation strategy for longitudinal studies when missingness is attributable to illness severity. Conduct of MNAR sensitivity analyses may be less critical after mechanical circulatory support implant, when there are likely fewer MNAR data.
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Affiliation(s)
- Kathleen L Grady
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.).
| | - Philip G Jones
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - Adin Cristian-Andrei
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - David C Naftel
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - Susan Myers
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - Mary Amanda Dew
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - Katharine Idrissi
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - Gerdi Weidner
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - Sherri A Wissman
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - James K Kirklin
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
| | - John A Spertus
- From the Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL (K.L.G., A.C.-A.); Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City, MO (P.G.J., J.A.S.); Department of Surgery, University of Alabama, Birmingham, AL (D.C.N., S.M., J.K.K.); Department of Psychiatry, University of Pittsburgh, PA (M.A.D.); Department of Surgery, Columbia University, New York, NY (K.I.); Department of Biology, San Francisco State University, CA (G.W.); The Ohio State University, Columbus (S.A.W.)
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Elmously A, de Biasi AR, Risucci DA, Worku B, Horn EM, Salemi A. Systemic blood pressure trends and antihypertensive utilization following continuous-flow left ventricular assist device implantation: an analysis of the interagency registry for mechanically assisted circulatory support. J Thorac Dis 2018; 10:2866-2875. [PMID: 29997951 DOI: 10.21037/jtd.2018.05.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps. Methods We identified all CF-LVAD implantations in patients older than 18 years from 2006-2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status were tabulated, extending up to 5 years following implantation. Results A total of 10,329 CF-LVAD implantations were included for study. Post-implant, SBPs increased rapidly during the first 3 months but plateaued thereafter; AH utilization mirrored this trend. By 6 months, mean MAPs climbed 12.2% from 77.6 mmHg (95% CI: 77.4-77.8) pre-implantation to 87.1 mmHg (95% CI: 86.7-87.4) and patients required a mean of 1.8 AH medications (95% CI: 1.75-1.78) -a 125% increase from AH use at 1-week post-implantation (0.8 AHs/patient, 95% CI: 0.81-0.83) but a 5.3% decrease from pre-implant utilization (1.9 AHs/patient, 95% CI: 1.90-1.92). Once medication changes stabilized, the most common AH regimens were lone beta blockade (15%, n=720) and a beta blocker plus an ACE inhibitor (14%, n=672). Conclusions SBP rises rapidly after CF-LVAD implantation, stabilizing after 3 months, and is matched by concomitant changes in AH utilization; this AH use has increased over consecutive implant years.
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Affiliation(s)
- Adham Elmously
- Department of Cardiothoracic Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
| | - Andreas R de Biasi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
| | - Donald A Risucci
- Department of Surgery, New York Methodist Hospital, New York, NY, USA.,Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
| | - Evelyn M Horn
- Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
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Robertson JO, Naftel DC, Myers SL, Tedford RJ, Joseph SM, Kirklin JK, Silvestry SC. Concomitant mitral valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis. J Heart Lung Transplant 2018; 37:79-88. [DOI: 10.1016/j.healun.2017.09.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022] Open
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Cowger JA, Naka Y, Aaronson KD, Horstmanshof D, Gulati S, Rinde-Hoffman D, Pinney S, Adatya S, Farrar DJ, Jorde UP. Quality of life and functional capacity outcomes in the MOMENTUM 3 trial at 6 months: A call for new metrics for left ventricular assist device patients. J Heart Lung Transplant 2018; 37:15-24. [DOI: 10.1016/j.healun.2017.10.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/03/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
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Nair N, Gongora E. Reviewing the use of ventricular assist devices in the elderly: where do we stand today? Expert Rev Cardiovasc Ther 2017; 16:11-20. [PMID: 29235399 DOI: 10.1080/14779072.2018.1417039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Implantation of left ventricular assist devices (LVADS) in older patients appears to be an attractive option in the wake of donor shortage and increasing incidence and prevalence of end stage heart failure. Since the inception of the artificial heart program half a century ago tremendous progress in research and development has led to utilization of more sophisticated devices. VADs have therefore emerged as a successful therapy for extending life with meaningful quality. Areas covered: This review will address the use of LVADS as a bridge to transplantation, destination therapy and comparison of LVAD therapy with alternate list heart transplantation in the elderly population. Expert commentary: Age >70 years is an important aspect when assessing LVAD risk, but other characteristics appear to be better predictors of LVAD survival. Elevated pre-operative creatinine, bilirubin and ischemic etiology predispose to a higher risk of mortality. Creatinine has been shown to be a very powerful predictor in post LVAD survival. Based on the existing literature, the authors suggest an algorithm which could be useful when evaluating patients for LVAD implantation.
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Affiliation(s)
- Nandini Nair
- a Division of Cardiology/Department of Internal Medicine , Advanced Heart Failure/ECMO/Transplant Services, Texas Tech Health Sciences Center/UMC , Lubbock , TX , USA
| | - Enrique Gongora
- b Adult Cardiac Surgical Transplant Program , Memorial Cardiac and Vascular Institute , Hollywood , FL , USA
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Chew DS, Manns B, Miller RJ, Sharma N, Exner DV. Economic Evaluation of Left Ventricular Assist Devices for Patients With End Stage Heart Failure Who Are Ineligible for Cardiac Transplantation. Can J Cardiol 2017; 33:1283-1291. [DOI: 10.1016/j.cjca.2017.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/18/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022] Open
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Stehlik J, Estep JD, Selzman CH, Rogers JG, Spertus JA, Shah KB, Chuang J, Farrar DJ, Starling RC. Patient-Reported Health-Related Quality of Life Is a Predictor of Outcomes in Ambulatory Heart Failure Patients Treated With Left Ventricular Assist Device Compared With Medical Management. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003910. [DOI: 10.1161/circheartfailure.116.003910] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
Background—
The prospective observational ROADMAP study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management) demonstrated that ambulatory advanced heart failure patients selected for left ventricular assist device (LVAD) were more likely to be alive at 1 year on original therapy with ≥75-m improvement in 6-minute walk distance compared with patients assigned to optimal medical management. Whether baseline health-related quality of life (hrQoL) resulted in a heterogeneity of this treatment benefit is unknown.
Methods and Results—
Patient-reported hrQoL was assessed with EuroQol questionnaire and visual analogue scale (VAS). We aimed to identify predictors of event-free survival and survival with acceptable hrQoL (VAS≥60). LVAD patients had significant improvement in 3 of 5 EuroQol dimensions (
P
<0.05), but no significant changes were observed with optimal medical management. Among patients with baseline VAS<55, survival on original treatment was lower for optimal medical management patients compared with those assigned to LVAD (58±7% versus 82±5%;
P
=0.004). No such difference was seen if baseline VAS was ≥55 (70±7% versus 75±9%;
P
=0.79). Survival on original therapy with acceptable quality of life was also more likely with LVAD versus optimal medical management if baseline VAS was <55, whereas outcomes in patients with higher baseline VAS scores were similar regardless of treatment assignment (
P
=0.046 for treatment arm and baseline VAS interaction).
Conclusions—
LVAD therapy resulted in improvement of patient health status in heart failure patients with low self-reported hrQoL, but not in patients with acceptable quality of life at the time of LVAD implantation. Patient-reported hrQoL should be integrated into decision making concerning the use and timing of LVAD therapy in heart failure patients who are symptom limited but remain ambulatory.
Clinical Trial Registration—
URL:
http://www.ClinicalTrials.gov
. Unique identifier: NCT01452802.
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Affiliation(s)
- Josef Stehlik
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Jerry D. Estep
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Craig H. Selzman
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joseph G. Rogers
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - John A. Spertus
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Keyur B. Shah
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joyce Chuang
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - David J. Farrar
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Randall C. Starling
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
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Fendler TJ, Nassif ME, Kennedy KF, Joseph SM, Silvestry SC, Ewald GA, LaRue SJ, Vader JM, Spertus JA, Arnold SV. Global Outcome in Patients With Left Ventricular Assist Devices. Am J Cardiol 2017; 119:1069-1073. [PMID: 28160976 DOI: 10.1016/j.amjcard.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Abstract
Left ventricular assist devices (LVADs) improve survival and quality of life (QOL) for most, but not all, patients with advanced heart failure. We described a broader definition of poor outcomes after LVAD, using a novel composite of death, QOL, and other major adverse events. We evaluated the frequency of poor global outcome at 1 year after LVAD among 164 patients (86% Interagency Registry for Mechanically Assisted Circulatory Support profile 1 to 2; shock or declining despite inotropes) at a high-volume center. Poor global outcome (comprising death, poor QOL [Kansas City Cardiomyopathy Questionnaire <45], recurrent heart failure [≥2 heart failure readmissions], or severe stroke) occurred in 58 patients (35%): 37 died, 17 had poor QOL, 3 had recurrent heart failure, and 1 had a severe stroke. Patients with poor global outcomes were more likely designated for destination therapy (46% vs 24%, p = 0.01), spent more days hospitalized per month alive (median [interquartile range] 18.6 [5.0 to 31.0] vs 3.7 [1.8 to 8.3], p <0.001), and had higher intracranial (12% vs 2%, p = 0.031) and gastrointestinal (44% vs 28%, p = 0.056) hemorrhage rates over the year after implant. Although LVADs often improve survival and QOL, ∼1/3 of high-acuity patients experienced a poor global outcome over the year after LVAD. In conclusion, composite outcomes may better capture events that matter to patients with LVADs and thus support informed decisions about pursuing LVAD therapy.
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Affiliation(s)
- Timothy J Fendler
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Michael E Nassif
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri
| | - Kevin F Kennedy
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Susan M Joseph
- Department of Cardiology, Baylor University Medical Center, Dallas, Texas
| | - Scott C Silvestry
- Department of Cardiovascular Surgery, Florida Hospital Transplant Institute, Florida Hospital, Orlando, Florida
| | - Gregory A Ewald
- Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri
| | - Shane J LaRue
- Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri
| | - Justin M Vader
- Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri
| | - John A Spertus
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Suzanne V Arnold
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri
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Ciarka A, Edwards L, Nilsson J, Stehlik J, Lund LH. Trends in the use of mechanical circulatory support as a bridge to heart transplantation across different age groups. Int J Cardiol 2017; 231:225-227. [DOI: 10.1016/j.ijcard.2016.10.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 10/18/2016] [Indexed: 11/16/2022]
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Reporte del primer caso de implante exitoso de asistencia ventricular izquierda HeartMate II como terapia de destino en Suramérica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Weerahandi H, Goldstein N, Gelfman LP, Jorde U, Kirkpatrick JN, Marble J, Naka Y, Pinney S, Slaughter MS, Bagiella E, Ascheim DD. Pain and Functional Status in Patients With Ventricular Assist Devices. J Pain Symptom Manage 2016; 52:483-490.e1. [PMID: 27401516 PMCID: PMC5897591 DOI: 10.1016/j.jpainsymman.2016.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/26/2016] [Accepted: 05/22/2016] [Indexed: 01/10/2023]
Abstract
CONTEXT Ventricular assist devices (VADs) have been shown to improve survival and overall quality of life, but there are limited data on pain control and functional status in this patient population. OBJECTIVES This study examined changes in pain, functional status, and quality of life over time in VAD patients. METHODS Patients were enrolled in this prospective cohort study before or as early after VAD implant as possible and then followed for up to 48 weeks. The Brief Pain Inventory was used to assess pain. The Katz Independent Activities of Daily Living questionnaire was used to assess functional status. The Kansas City Cardiomyopathy Questionnaire, a 23-item questionnaire covering five domains (physical function, symptoms, social function, self-efficacy, and quality of life), was used to assess quality of life and health status. RESULTS Eighty-seven patients were enrolled at four medical centers. The median Brief Pain Inventory severity score was 2.8 (interquartile range 0.5-5.0) before implantation and 0.0 (interquartile range 0.0-5.3) 48 weeks after implantation (P = 0.0009). Katz Independent Activities of Daily Living summary scores also demonstrated significant improvement over time (P < 0.0001). Kansas City Cardiomyopathy Questionnaire summary scales demonstrated significant improvement with time (P < 0.0016). CONCLUSION This study demonstrated that patients with VADs experienced improved pain, functional status, and quality of life over time. These data may be useful to help patients make decisions when they are considering undergoing VAD implantation.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Nathan Goldstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P Gelfman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ulrich Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - James N Kirkpatrick
- Department of Medicine, University of Washington Medicine, Seattle, Washington, USA
| | - Judith Marble
- Department of Surgery, Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoshifumi Naka
- Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Sean Pinney
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark S Slaughter
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Jewish Hospital Louisville, Louisville, Kentucky, USA
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhou C, Wang D, Ballard-Croft C, Zhao G, Reda HK, Topaz S, Zwischenberger J. A transapical-to-aorta double lumen cannula-based neonate left ventricular assist device efficiently unloads the left ventricle in neonate lambs. J Thorac Cardiovasc Surg 2016; 153:175-182. [PMID: 27692763 DOI: 10.1016/j.jtcvs.2016.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We are developing a transapical-to-aorta double lumen cannula (TAA DLC) for a less-invasive/more dependable neonatal left ventricular assist device. METHODS The 18-Fr TAA DLC prototypes were bench tested and evaluated for 6 hours in neonate lambs (n = 6, 7.7-10 kg). The cardiac apex was exposed through a left anterolateral thoracotomy through the sixth intercostal space. The TAA DLC was inserted through a mattress stitch on apex, passing LV-aortic valve, into the ascending aorta with insertion/deployment guided by pressure waveform. The DLC was connected to blood pump. Cardiac output and aortic root blood flow were measured with perivascular flow sensors. Activated clotting time was maintained at 180-250 seconds. RESULTS The DLC pumped up to 1.8 L/min flow against 63 mm Hg drainage pressure and 145 mm Hg infusion pressure in bench testing. In all lambs, the DLC was inserted/deployed properly within 1 minute on the first attempt. Pumping flow was maintained at 1.2-1.3 L/min. Systolic arterial pressure decreased and diastolic arterial pressure/mean arterial pressure increased, indicating decreased afterload and increased perfusion pressure. Left ventricular end-diastolic pressure decreased from 13 ± 1 mm Hg to 6 ± 2 mm Hg, indicating decreased preload. Aortic root backward flow was 2.4% ± 0.6% without DLC and 3.5% ± 0.8% of cardiac output with DLC, indicating no significant DLC-induced aortic valve regurgitation. After 6 hours, free hemoglobin was <5 mg/dL with hemoglobin/platelets unchanged. No significant thrombus was found in pumps/DLCs. No trauma was found in LV, aortic valve, and aorta. CONCLUSIONS Our TAA DLC-based neonate left ventricular assist device efficiently unloaded the LV in lambs.
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Affiliation(s)
- Cheng Zhou
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Ky; Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongfang Wang
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Ky.
| | | | | | - Hassan K Reda
- Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Ky
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Grady KL, Sherri Wissman, Naftel DC, Myers S, Gelijins A, Moskowitz A, Pagani FD, Young JB, Spertus JA, Kirklin JK. 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. J Heart Lung Transplant 2016; 35:777-88. [PMID: 27068037 DOI: 10.1016/j.healun.2016.01.1222] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 12/11/2015] [Accepted: 01/28/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%). CONCLUSIONS 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.
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Affiliation(s)
- Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Sherri Wissman
- Comprehensive Transplant Center, Ohio State University Medical Center, Columbus, Ohio
| | - David C Naftel
- Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama
| | - Susan Myers
- Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama
| | - Annetine Gelijins
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York
| | - Alan Moskowitz
- Departments of Medicine and Population Health Science and Policy, Mount Sinai Medical Center, New York, New York
| | - Francis D Pagani
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - James B Young
- Department of Medicine, Cleveland Clinic Foundation Lerner College of Medicine, Cleveland, Ohio
| | - John A Spertus
- 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
| | - James K Kirklin
- Department of Surgery, University of Alabama, Birmingham, Birmingham, Alabama
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