scholarly journals Factors Associated With Health‐Related Quality of Life 2 Years After Left Ventricular Assist Device Implantation: Insights From INTERMACS

2021 ◽  
Author(s):  
Kathleen L. Grady ◽  
Pariya L. Fazeli ◽  
James K. Kirklin ◽  
Salpy V. Pamboukian ◽  
Connie White‐Williams
Keyword(s):  
Heart Transplant ◽  
Left Ventricular ◽  
Short Term ◽  
Ventricular Assist ◽  
Factors Associated ◽  
Vas Score ◽  
Related Quality ◽  
Health Related ◽  
Related Stress

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.

Health-Related Quality of Life in Patients with a Left Ventricular Assist Device Questionnaire

2021 ◽  
Author(s):  
Kristin E. Sandau ◽  
Christopher S. Lee ◽  
Kenneth M. Faulkner ◽  
Bunny Pozehl ◽  
Peter Eckman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Left Ventricular Assist Device ◽  
Left Ventricular ◽  
Health Related Quality ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Related Quality ◽  
Health Related

Fatigue Is the Major Aspect Compromising Health-Related Quality of Life of Chronic Myeloid Leukemia Patients Receiving Long-Term Imatinib Therapy

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4234-4234
Author(s):  
Fabio Efficace ◽  
Michele Baccarani ◽  
Massimo Breccia ◽  
Francesco Cottone ◽  
Gianantonio Rosti ◽  
...  
Keyword(s):  
Social Support ◽  
Myeloid Leukemia ◽  
Imatinib Therapy ◽  
Health Related Quality ◽  
Factors Associated ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract Abstract 4234 Background: Whilst recent data indicates that survival of chronic myeloid leukemia (CML) patients, who are in complete cytogenetic response (CCyR) with Imatinib therapy, is not statistically significantly different from that of the general population, health-related quality of life (HRQOL) differences do exist. However, to date no study has investigated the predictive factors of long-term HRQOL outcomes of CML patients treated with TKIs. Aim: The main objective of this study was to investigate potential key factors associated with long-term HRQOL outcomes of CML patients in CCyR treated with first line Imatinib therapy. A secondary objective was to investigate the relationships between fatigue and other treatment related symptoms and describe how fatigue relates to socio-demographic and clinical data. Patients and Methods: Analysis was performed on 422 CML patients recruited in an observational multicenter study. Median time in treatment with Imatinib was five years (range: 3 to 9.3 years). HRQOL was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). This questionnaire consists of 36 items covering eight generic HRQOL domains: physical functioning (PF), role limitations due to physical health (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Predictor variables investigated included, fatigue and social support, measured with two psychometrically robust questionnaires, that is the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale and the multidimensional scale of perceived social support (MSPSS) scale. Other CML treatment related symptoms were measures with an ad hoc CML symptom checklist. Key socio-demographic and clinical data including, age, gender, education, Sokal risk, response to therapy and duration of treatment, were also considered. Univariate and multivariate regression analyses were used to identify a set of independent predictors for each SF-36 scale, via a stepwise selection procedure. Results: In the multivariate analysis the following factors independently predicted a better PF: younger age (P<0.001), being male (P<0.001), higher education (P=0.002), and less fatigue(P<0.001). Together, this set of variables explained 56% of the variance in the PF scale. Fatigue was the only variable showing an independent and consistent association across all HRQOL domains measured by the SF-36. Role physical (RP) and role emotional (RE) scales (SF-36) were found to be the two mostly compromised aspects by fatigue severity. As fatigue was found to be the main predictor variable, for descriptive purposes in figure 1 we report mean scores of the SF-36 scales by levels of fatigue. Mean score differences, between patients reporting low versus high fatigue levels, were respectively 70 and 63 points for the RP and RE scales. Higher perceived social support independently predicted better social functioning (P<.001) and mental health (P<.001). Hb levels, measured at the most recent follow-up visit (mean time 2.9 weeks), showed a weak correlation (r=.187) with fatigue. Higher levels of fatigue were more common in those patients who already had comorbidity at diagnosis and in female patients. Patients who reported higher levels of fatigue also reported a higher severity of other CML symptoms. Conclusion: To our knowledge, this was the first investigation to date of factors associated with long-term HRQOL in CML patients being treated with an oral anticancer-targeted therapy. Our findings suggest that although responding to Imatinib therapy, long-term patient's HRQOL is greatly affected by fatigue levels. Also, our results suggest that symptom management is crucial to the possible improvement of HRQOL outcomes. Legend: Low, Low-Medium, Medium-High and High correspond respectively to the 4th (75th to 100th percentile), 3rd, 2nd and 1st (0th to 25th percentile) quartile of FACIT-Fatigue scale. On this scale, the higher the score the lower is the level of fatigue. Disclosures: Efficace: Bristol Myers Squibb: Consultancy; Novartis: Research Funding. Baccarani:Novartis : Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Pfizer and Ariad: Honoraria. Breccia:Bristol Myers Squibb: Consultancy; Novartis: Consultancy. Rosti:Novartis: Consultancy, Honoraria, Research Funding; Bristol Myers Squibb: Consultancy, Honoraria. Alimena:Novartis: Honoraria; Bristol Myers Squibb: Honoraria. Turri:Novartis: Consultancy, Novartis Other; Bristol Myers Squibb: Bristol Myers Squibb, Bristol Myers Squibb Other, Consultancy.

Abstract 13871: Heart Transplant Recipients Enjoy Higher Health-related Quality of Life than Left Ventricular Assist Device Recipients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shunsuke Saito ◽  
Koichi Toda ◽  
Teruya Nakamura ◽  
Shigeru Miyagawa ◽  
Yasushi Yoshikawa ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Inotropic Support ◽  
Ventricular Assist ◽  
Sf 36 ◽  
Left Ventricular Assist ◽  
Related Quality ◽  
Health Related ◽  
Lvad Support ◽  
Component Scores

Introduction: The aim of this study was to evaluate and compare health-related quality of life (HRQoL) in patients waiting for heart transplantation (HTx) on inotropic support or on left ventricular assist device (LVAD) support and in patients after HTx. Methods: A prospective, comparative design was used to characterize changes over time in HRQoL (SF-36) in patients waiting for HTx on inotropic support (Group-Ino: n = 12) or on LVAD support (Group-LVAD: n = 16) and in patients after HTx (Group:HTx: n = 19). Results: LVAD or HTx free survivals at 1 and 2 years of Group-Ino, Group-LVAD, and Group-HTx were 44% and 33%, 100% and 82%, and 100% and 100%, respectively. Actuarial survivals at 1 and 5 year of the 3 groups were 100% and 89%, 100% and 100%, and 100% and 100%, respectively. The patients on inotropic support stayed hospitalized all through the waiting time, while 31% of patients on LVAD support went back to work or school, and 63% of patients did so after HTx. The SF-36 psychosocial component scores were unexpectedly high in all the 3 groups: 47.9±10.3 in Group-Ino, 51.4±12.5 in Group-LVAD, and 54.5±7.6 in Group-HTx (norm-based scoring, differences not significant among the 3 groups). On the other hand, the SF-36 physical component score was significantly higher in Group-HTx (45.7±11.7) than in Group-Ino (3.9±11.7, p < 0.01) and in Group-LVAD (25.2±18.9, p < 0.01). The changes of treatment status resulted in significant increase in the SF-36 physical component scores: Ino --> LVAD: 16.7±17.2 points, Ino --> HTx: 46.3±12.5 points, LVAD --> HTx: 19.6±28.2 points. Conclusion: Although the survival after LVAD implantation was as good as that after HTx, HRQoL in HTx recipients was significantly higher than that in LVAD recipients.

Abstract P435: Medical and Neurosurgical Interventions in Left Ventricular Assist Device-Associated Intracranial Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Chinwe Ibeh ◽  
David L TIRSCHWELL ◽  
Claudius Mahr ◽  
Claire J Creutzfeldt
Keyword(s):  
Intracranial Hemorrhage ◽  
Heart Transplant ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Hematoma Expansion ◽  
Term Survival ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Short And Long Term

Background: Management of intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVADs) is complicated by the competing concerns of hematoma expansion and the risk of thrombotic events. Strategies include reversal or withholding of anticoagulation (AC) and neurosurgical (NSG) interventions. The consequences of these decisions can significantly impact both short- and long-term survival. Currently no guidelines on management exist. We reviewed medical and NSG practices and subsequent outcomes at a single academic center. Methods: We retrospectively identified all patients within our institutional LVAD database who developed ICH between 2012-2018. Demographic, clinical, and outcome data were analyzed. Results: Of 283 LVAD patients, 32 (11%) had 34 ICHs: 16 intraparenchymal (IPH, 47%), 4 subdural (SDH, 12%), and 14 subarachnoid (SAH, 41%). IPH occurred sooner than other subtypes (median 138 [48 - 258]) days post-LVAD placement vs SDH (431 [22 - 915] days) and SAH (484 [272 - 990] days). Mean GCS was 12.9 (3.7). All patients were on AC with a mean INR of 3.3 (range 1.2 - 7.0). AC was reversed in 27 (79%) patients, most frequently with a combination of Vit K (56%), FFP (47%), or PCC (26%). AC was held in 31 patients a median of 4 (2.0 - 9.0) days; 1 thrombotic event occurred while off AC (spinal cord infarct). After AC resumption, 16 thrombotic events occurred a median of 15 (8.0-37.0) days post-ICH and led to death in most (79%) by 6 months. Five patients underwent NSG intervention: 1 hemicraniectomy, 3 EVDs, and 1 aneurysm coiling. Six patients (18%) went on to receive heart transplant. Overall, 30-day mortality was 26%. IPH had the highest 30-day mortality (38% vs SDH, 0% and SAH, 29%). At 6 months, overall mortality was 44%. Conclusion: ICH is a common post-LVAD complication with high short- and long-term mortality. Of the subtypes, IPH was the most common, most deadly and occurred the earliest following LVAD placement. At our institution, most patients underwent AC reversal but AC was also resumed rapidly. Delayed thrombotic complications nearly doubled 6-month mortality. The development of ICH did not preclude successful heart transplant. Further research in the care of LVAD patients with ICH may help improve these short- and long-term outcomes.

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