1
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Yang G, Zhang M, Zhou S, Hou H, Grady KL, Stewart JW, Chenoweth CE, Aaronson KD, Fetters MD, Chandanabhumma PP, Pienta MJ, Malani PN, Hider AM, Cabrera L, Pagani FD, Likosky DS. Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric. J Heart Lung Transplant 2022; 41:1520-1528. [PMID: 35961829 PMCID: PMC10405265 DOI: 10.1016/j.healun.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons' Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. METHODS Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire "KCCQ") incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. RESULTS The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). CONCLUSIONS Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.
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Affiliation(s)
- Guangyu Yang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James W Stewart
- Division of Cardiac Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Carol E Chenoweth
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael D Fetters
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - P Paul Chandanabhumma
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael J Pienta
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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2
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Hu RT, Royse AG, Royse C, Scott DA, Bowyer A, Boggett S, Summers P, Mazer CD. Health-related quality of life after restrictive versus liberal RBC transfusion for cardiac surgery: Sub-study from a randomized clinical trial. Transfusion 2022; 62:1973-1983. [PMID: 36066319 DOI: 10.1111/trf.17084] [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: 04/19/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transfusion Requirements in Cardiac Surgery III (TRICS III), a multi-center randomized controlled trial, demonstrated clinical non-inferiority for restrictive versus liberal RBC transfusion for patients undergoing cardiac surgery. However, it is uncertain if transfusion strategy affects long-term health-related quality of life (HRQOL). STUDY DESIGN AND METHODS In this planned sub-study of Australian patients in TRICS III, we sought to determine the non-inferiority of restrictive versus liberal transfusion strategy on long-term HRQOL and to describe clinical outcomes 24 months postoperatively. The restrictive strategy involved transfusing RBCs when hemoglobin was <7.5 g/dl; the transfusion triggers in the liberal group were: <9.5 g/L intraoperatively, <9.5 g/L in intensive care, or <8.5 g/dl on the ward. HRQOL assessments were performed using the 36-item short form survey version 2 (SF-36v2). Primary outcome was non-inferiority of summary measures of SF-36v2 at 12 months, (non-inferiority margin: -0.25 effect size; restrictive minus liberal scores). Secondary outcomes included non-inferiority of HRQOL at 18 and 24 months. RESULTS Six hundred seventeen Australian patients received allocated randomization; HRQOL data were available for 208/311 in restrictive and 217/306 in liberal group. After multiple imputation, non-inferiority of restrictive transfusion at 12 months was not demonstrated for HRQOL, and the estimates were directionally in favor of liberal transfusion. Non-inferiority also could not be concluded at 18 and 24 months. Sensitivity analyses supported these results. There were no differences in quality-adjusted life years or composite clinical outcomes up to 24 months after surgery. DISCUSSION The non-inferiority of a restrictive compared to a liberal transfusion strategy was not established for long-term HRQOL in this dataset.
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Affiliation(s)
- Raymond T Hu
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Alistair G Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Outcomes Research Consortium, The Cleveland Clinic, Cleveland, Ohio, USA
| | - David A Scott
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andrea Bowyer
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stuart Boggett
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Summers
- Statistical Consulting Centre, University of Melbourne, Parkville, Victoria, Australia.,Melbourne Disability Institute, University of Melbourne, Parkville, Victoria, Australia.,Centre for Health Analytics, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Cyril David Mazer
- Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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3
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Rösel I, Serna-Higuita LM, Al Sayah F, Buchholz M, Buchholz I, Kohlmann T, Martus P, Feng YS. What difference does multiple imputation make in longitudinal modeling of EQ-5D-5L data? Empirical analyses of simulated and observed missing data patterns. Qual Life Res 2022; 31:1521-1532. [PMID: 34797507 PMCID: PMC9023409 DOI: 10.1007/s11136-021-03037-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Although multiple imputation is the state-of-the-art method for managing missing data, mixed models without multiple imputation may be equally valid for longitudinal data. Additionally, it is not clear whether missing values in multi-item instruments should be imputed at item or score-level. We therefore explored the differences in analyzing the scores of a health-related quality of life questionnaire (EQ-5D-5L) using four approaches in two empirical datasets. METHODS We used simulated (GR dataset) and observed missingness patterns (ABCD dataset) in EQ-5D-5L scores to investigate the following approaches: approach-1) mixed models using respondents with complete cases, approach-2) mixed models using all available data, approach-3) mixed models after multiple imputation of the EQ-5D-5L scores, and approach-4) mixed models after multiple imputation of EQ-5D 5L items. RESULTS Approach-1 yielded the highest estimates of all approaches (ABCD, GR), increasingly overestimating the EQ-5D-5L score with higher percentages of missing data (GR). Approach-4 produced the lowest scores at follow-up evaluations (ABCD, GR). Standard errors (0.006-0.008) and mean squared errors (0.032-0.035) increased with increasing percentages of simulated missing GR data. Approaches 2 and 3 showed similar results (both datasets). CONCLUSION Complete cases analyses overestimated the scores and mixed models after multiple imputation by items yielded the lowest scores. As there was no loss of accuracy, mixed models without multiple imputation, when baseline covariates are complete, might be the most parsimonious choice to deal with missing data. However, multiple imputation may be needed when baseline covariates are missing and/or more than two timepoints are considered.
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Affiliation(s)
- Inka Rösel
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Medical Clinic, Department of Sports Medicine, University Hospital Tuebingen, Tübingen, Germany
| | - Lina María Serna-Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Fatima Al Sayah
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, Alberta, Canada
| | - Maresa Buchholz
- Institute for Nursing Science and Interprofessional Education, Medical University Greifswald, Greifswald, Germany
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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4
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Mehaffey JH, Cantor R, Myers S, Teman NR, Kern JA, Ailawadi G, Pagani F, Kirklin J, Yount K, Yarboro L. Impact of preoperative versus postoperative dialysis on left ventricular assist device outcomes: An analysis from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support database. JTCVS OPEN 2022; 9:122-143. [PMID: 36003469 PMCID: PMC9390495 DOI: 10.1016/j.xjon.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J. Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala
| | - Susan Myers
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala
| | - Nicholas R. Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - John A. Kern
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
- Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Francis Pagani
- Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - James Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Ala
| | - Kenan Yount
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Leora Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
- Address for reprints: Leora Yarboro, MD, Department of Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA 22903.
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5
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Maukel L, Weidner G, Beyersmann J, Spaderna H. Sex Differences in Recovery and Device Replacement After Left Ventricular Assist Device Implantation as Destination Therapy. J Am Heart Assoc 2022; 11:e023294. [PMID: 35191318 PMCID: PMC9075087 DOI: 10.1161/jaha.121.023294] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The relevance of sex and preimplant factors for clinical outcomes among patients with left ventricular assist devices intended for destination therapy is unclear. Methods and Results INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) data (2006-2017) from 6771 men and 1690 women with left ventricular assist devices as destination therapy were analyzed to evaluate the contribution of preimplant clinical, demographic, and clinically judged psychosocial characteristics to time until death, heart transplant, device explant due to recovery, or complication-related device replacement. Associations of sex with time until each competing outcome were evaluated using cumulative incidence functions and event-specific Cox proportional hazards models. Women were younger, more likely to have nonischemic diagnoses, and reported less substance abuse but were more likely to be unmarried, not working for an income, overweight, and depressed than men. After 2 years, women had higher probabilities for recovery (3.7% versus 1.6%, P<0.001) and device replacement (12.1% versus 10%, P=0.019) than men but not for death and transplant (P>0.12). The sex differences remained after controlling for covariates (adjusted hazard ratio [HRadj] recovery, 1.85; 95% CI, 1.30-2.70; P<0.001; HRadj device replacement, 1.22; 95% CI, 1.04-1.33; P=0.015). Female-specific diagnoses (eg, postpartum heart failure) contributed to women's enhanced rate of recovery. Demographic and psychosocial factors were unrelated to women's increased event rates. Conclusions In destination therapy, women have higher rates of device replacement and recovery than men. The latter was partly explained by female-specific diagnoses. Standardized assessments of psychosocial characteristics are needed to elucidate their association with sex differences in outcomes.
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Affiliation(s)
| | - Gerdi Weidner
- Biology, San Francisco State UniversitySan FranciscoCA
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6
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Kalf RRJ, Delnoij DMJ, Ryll B, Bouvy ML, Goettsch WG. Information Patients With Melanoma Spontaneously Report About Health-Related Quality of Life on Web-Based Forums: Case Study. J Med Internet Res 2021; 23:e27497. [PMID: 34878994 PMCID: PMC8693198 DOI: 10.2196/27497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/27/2021] [Accepted: 09/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background There is a general agreement on the importance of health-related quality of life (HRQoL). This type of information is becoming increasingly important for the value assessment of health technology assessment agencies in evaluating the benefits of new health technologies, including medicines. However, HRQoL data are often limited, and additional sources that provide this type of information may be helpful. Objective We aim to identify the HRQoL topics important to patients with melanoma based on web-based discussions on public social media forums. Methods We identified 3 public web-based forums from the United States and the United Kingdom, namely the Melanoma Patient Information Page, the Melanoma International Forum, and MacMillan. Their posts were randomly selected and coded using qualitative methods until saturation was reached. Results Of the posts assessed, 36.7% (150/409) of posts on Melanoma International Forum, 45.1% (198/439) on MacMillan, and 35.4% (128/362) on Melanoma Patient Information Page focused on HRQoL. The 2 themes most frequently mentioned were mental health and (un)certainty. The themes were constructed based on underlying and more detailed codes. Codes related to fear, worry and anxiety, uncertainty, and unfavorable effects were the most-often discussed ones. Conclusions Web-based forums are a valuable source for identifying relevant HRQoL aspects in patients with a given disease. These aspects could be cross-referenced with existing tools and they might improve the content validity of patient-reported outcome measures, including HRQoL questionnaires. In addition, web-based forums may provide health technology assessment agencies with a more holistic understanding of the external aspects affecting patient HRQoL. These aspects might support the value assessment of new health technologies and could therefore help inform topic prioritization as well as the scoping phase before any value assessment.
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Affiliation(s)
- Rachel R J Kalf
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, Netherlands.,National Health Care Institute, Diemen, Netherlands
| | - Diana M J Delnoij
- National Health Care Institute, Diemen, Netherlands.,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bettina Ryll
- Melanoma Patient Network Europe, Uppsala, Sweden
| | - Marcel L Bouvy
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, Netherlands
| | - Wim G Goettsch
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, Netherlands.,National Health Care Institute, Diemen, Netherlands
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7
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Löchel S, Maukel LM, Weidner G, de By TMMH, Spaderna H. Gender differences in psychosocial and clinical characteristics in the European Registry for Patients with Mechanical Circulatory Support. Heart Lung 2021; 50:845-852. [PMID: 34325182 DOI: 10.1016/j.hrtlng.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Not much is known about psychosocial characteristics of men and women receiving continuous flow left ventricular assist devices (CF LVAD). OBJECTIVE To investigate gender differences in clinical and psychosocial (demographic, behavioral, psychological) characteristics in CF LVAD recipients. METHODS We analyzed European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data (N=2395, 16.8% women; 2011 to 2017) and compared pre-implant characteristics in men and women intended for bridge-to-transplant (BTT) or destination therapy (DT). RESULTS Women were underrepresented [DT (n=61): 13.4%; BTT (n=341): 17.6%]. They were more likely to be divorced/separated, widowed, in unstable clinical condition, and non-working (DT only), but less likely to be smokers, to have ischemic cardiomyopathy or diabetes, and younger (BTT only) than men. Missing data were abundant, especially those that reflect psychological characteristics (>87%). CONCLUSION Gender differences were noted, some specific to device strategy. Improved collection of psychosocial characteristics is warranted to elucidate their relationship to future prognosis.
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Affiliation(s)
- Sarah Löchel
- Department of Nursing Science, Section Health Psychology, Trier University, Trier, Germany
| | - Lisa-Marie Maukel
- Department of Nursing Science, Section Health Psychology, Trier University, Trier, Germany
| | - Gerdi Weidner
- Department of Biology - EOS Center, San Francisco State University, San Francisco, CA, USA
| | - Theo M M H de By
- European Association for Cardio-Thoracic Surgery, EACTS House, Windsor, UK
| | - Heike Spaderna
- Department of Nursing Science, Section Health Psychology, Trier University, Trier, Germany.
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8
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Alonso WW, Faulkner KM, Pozehl BJ, Hupcey JE, Kitko LA, Lee CS. A longitudinal comparison of health-related quality of life in rural and urban recipients of left ventricular assist devices. Res Nurs Health 2020; 43:396-406. [PMID: 32627852 DOI: 10.1002/nur.22052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/23/2020] [Indexed: 12/31/2022]
Abstract
Left ventricular assist devices (LVAD) are a common treatment for advanced heart failure (HF) to improve ventricular function, symptoms, and health-related quality of life (HRQOL). Many LVAD recipients travel long distances from rural areas for LVAD implantation and follow-up care. Individuals with HF in rural settings who have not undergone LVAD implantation have reported poor HRQOL. However, to date, no studies have compared HF-specific or generic HRQOL in rural and urban LVAD recipients. The purpose of this study was to compare generic and HF-specific HRQOL longitudinally from preimplantation to 1-, 3-, and 6- months postimplant in a cohort of rural and urban LVAD recipients (n = 95; rural n = 32 and urban n = 63). We measured generic HRQOL using the European Quality of Life Visual Analog Scale and HF-specific HRQOL with the quality of life domain of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Latent growth curve modeling identified two phases of change in generic and HF-specific HRQOL: the initial response to LVAD between preimplantation and 1-month postimplant and the subsequent change between 1- and 6-months postimplant. Comparable improvements in generic HRQOL were noted in rural and urban LVAD recipients during both phases of change. Urban LVAD recipients had greater initial improvements in HF-specific HRQOL (KCCQ) compared with rural recipients (13.0 ± 5.6, p = .02), but subsequent improvements were similar among rural and urban recipients. Ongoing assessment of generic and HF-specific HRQOL is necessary during LVAD therapy.
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Affiliation(s)
- Windy W Alonso
- College of Nursing, Division of Omaha, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kenneth M Faulkner
- School of Nursing, Stony Brook University, Stony Brook, New York.,William F. Connell School of Nursing, Boston, Massachusetts
| | - Bunny J Pozehl
- College of Nursing, Division of Omaha, University of Nebraska Medical Center, Omaha, Nebraska
| | - Judith E Hupcey
- College of Nursing, University Park, The Pennsylvania State University, Pennsylvania
| | - Lisa A Kitko
- College of Nursing, University Park, The Pennsylvania State University, Pennsylvania
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9
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Purnajo I, Beaumont JL, Polinsky M, Alemao E, Everly MJ. Trajectories of health-related quality of life among renal transplant patients associated with graft failure and symptom distress: Analysis of the BENEFIT and BENEFIT-EXT trials. Am J Transplant 2020; 20:1650-1658. [PMID: 31874117 DOI: 10.1111/ajt.15757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/25/2023]
Abstract
Understanding the correlation between transplant symptoms, health-related quality of life (HRQoL), and graft outcomes is needed to support patient-focused drug development and posttransplant management. A post-hoc analysis of patient-reported outcomes from the Phase III belatacept trials was conducted in order to investigate the interrelationship between trajectories of HRQoL, symptom experience, and allograft outcomes. HRQoL and symptom experience were evaluated using Short-Form 36 Survey (SF-36) and Modified Transplant Symptom Occurrence and Distress Scale (MTSOSD-59R), respectively. HRQoL was captured in 831 eligible renal transplant patients at baseline, 12, 24, and 36 months posttransplant. Following transplantation, patients reported improvements in all SF-36 subscales compared to baseline. Latent class analysis revealed four trajectories in perceived general health, which were associated with graft failure after adjustment. Compared to patients with good perceived health, patients with fair and poor perceived health had 4.7 (95% confidence interval [CI] 1.5-14.8, P < .01) and 19.8 (95% CI 5.9-66.0, P < .01) times the risk of graft failure, respectively. Using multinomial logistic regression, different sets of symptoms were associated with perceived general health at baseline and 12 months posttransplant. The study supports monitoring HRQoL and symptom experience to capture each patient's health perspective, improve drug development, and optimize posttransplant management.
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Affiliation(s)
- Intan Purnajo
- Terasaki Research Institute, Los Angeles, California
| | | | | | - Evo Alemao
- Bristol Myers Squibb, Princeton, New Jersey
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10
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Streur MM, Beckman JA, Dougherty CM, Li S, Mahr C. Quality of life and rehabilitation after total artificial heart. Ann Cardiothorac Surg 2020; 9:128-130. [PMID: 32309166 DOI: 10.21037/acs.2020.02.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Megan M Streur
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer A Beckman
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Cynthia M Dougherty
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Song Li
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Claudius Mahr
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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11
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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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12
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Spertus JV, Hatfield LA, Cohen DJ, Arnold SV, Ho M, Jones PG, Leon M, Zuckerman B, Spertus JA. Integrating Quality of Life and Survival Outcomes in Cardiovascular Clinical Trials. Circ Cardiovasc Qual Outcomes 2019; 12:e005420. [PMID: 31189406 DOI: 10.1161/circoutcomes.118.005420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Survival and health status (eg, symptoms and quality of life) are key outcomes in clinical trials of heart failure treatment. However, health status can only be recorded on survivors, potentially biasing treatment effect estimates when there is differential survival across treatment groups. Joint modeling of survival and health status can address this bias. Methods and Results We analyzed patient-level data from the PARTNER 1B trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement versus standard care. Health status was quantified with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at randomization, 1, 6, and 12 months. We compared hazard ratios for survival and mean differences in KCCQ scores at 12 months using several models: the original growth curve model for KCCQ scores (ignoring death), separate Bayesian models for survival and KCCQ scores, and a Bayesian joint longitudinal-survival model fit to either 12 or 30 months of survival follow-up. The benefit of transcatheter aortic valve replacement on 12-month KCCQ scores was greatest in the joint-model fit to all survival data (mean difference, 33.7 points; 95% credible intervals [CrI], 24.2-42.4), followed by the joint-model fit to 12 months of survival follow-up (32.3 points; 95% CrI, 22.5-41.5), a Bayesian model without integrating death (30.4 points; 95% CrI, 21.4-39.3), and the original growth curve model (26.0 points; 95% CI, 18.7-33.3). At 12 months, the survival benefit of transcatheter aortic valve replacement was also greater in the joint model (hazard ratio, 0.50; 95% CrI, 0.32-0.73) than in the nonjoint Bayesian model (0.54; 95% CrI, 0.37-0.75) or the original Kaplan-Meier estimate (0.55; 95% CI, 0.40-0.74). Conclusions In patients with severe symptomatic aortic stenosis and prohibitive surgical risk, the estimated benefits of transcatheter aortic valve replacement on survival and health status compared with standard care were greater in joint Bayesian models than other approaches.
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Affiliation(s)
- Jacob V Spertus
- Department of Statistics, University of California, Berkeley (J.V.S.)
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H.)
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
| | - Martin Ho
- Center for Devices and Radiologic Health, Food and Drug Administration, Bethesda MD (M.H., B.Z.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.)
| | - Martin Leon
- Division of Cardiology, Columbia University, New York, NY (M.L.)
| | - Bram Zuckerman
- Center for Devices and Radiologic Health, Food and Drug Administration, Bethesda MD (M.H., B.Z.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City MO (D.J.C., S.V.A., P.G.J., J.A.S.).,Department of Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City MO (D.J.C., S.V.A., J.A.S.)
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End of life for patients with left ventricular assist devices: Insights from INTERMACS. J Heart Lung Transplant 2019; 38:374-381. [DOI: 10.1016/j.healun.2018.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022] Open
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