Impact of Early Major Adverse Events on Quality of Life After Mechanical Circulatory Support

PurposeThere is a paucity of data on quality of life (QoL) after mechanical circulatory support. We sought to determine if early nonfatal major adverse events (MAEs) negatively impact QoL.MethodsAll CF LVADs from 1/08 to 10/13 at a single institution, who consented to serial assessments of QoL were included. The Short-Form General Health Survey (SF-36) was administered at 1, 3, and 6 months post implant. The scores range from 0 (worst) to 100 (best). MAEs, as defined by INTERMACS, that occurred within the first 30 days post-implant were analyzed and included: right ventricular dysfunction, sepsis, respiratory failure, renal failure requiring hemodialysis or stroke.ResultsThere were 106 CF LVADs, with 81 (76%) with no MAE and 25 with non-fatal MAEs (24%) within 30 days post-implant. There were no differences in baseline characteristics between those with and without MAE: age 55 years, male 84%, white 80%, ischemic 51%, mean duration of support 387 (SD) days. Likewise, there was no difference in device distribution between the two groups: HeartMate II 53%, HVAD 36%, VentrAssist 10%, Jarvik 1%. More patients with destination therapy (60%) than bridge to transplant (40%) had MAEs. Patients who experienced MAEs had significantly lower SF-36 scores at 1 month in two of eight domains: role physical (2.5 v. 12.8, p = 0.002) and vitality (27.0 v. 38.6, p = 0.04). There was also a trend towards worse physical functioning (20.2 v. 30.2, p = 0.06). At 3 months, physical functioning remained lower in those who had early MAEs (33.6 v. 50.3, p = 0.018), but the other domains were not significantly different. By 6 months, there were no significant differences between the SF-36 scores in any domain.Conclusion PurposeThere is a paucity of data on quality of life (QoL) after mechanical circulatory support. We sought to determine if early nonfatal major adverse events (MAEs) negatively impact QoL. There is a paucity of data on quality of life (QoL) after mechanical circulatory support. We sought to determine if early nonfatal major adverse events (MAEs) negatively impact QoL. MethodsAll CF LVADs from 1/08 to 10/13 at a single institution, who consented to serial assessments of QoL were included. The Short-Form General Health Survey (SF-36) was administered at 1, 3, and 6 months post implant. The scores range from 0 (worst) to 100 (best). MAEs, as defined by INTERMACS, that occurred within the first 30 days post-implant were analyzed and included: right ventricular dysfunction, sepsis, respiratory failure, renal failure requiring hemodialysis or stroke. All CF LVADs from 1/08 to 10/13 at a single institution, who consented to serial assessments of QoL were included. The Short-Form General Health Survey (SF-36) was administered at 1, 3, and 6 months post implant. The scores range from 0 (worst) to 100 (best). MAEs, as defined by INTERMACS, that occurred within the first 30 days post-implant were analyzed and included: right ventricular dysfunction, sepsis, respiratory failure, renal failure requiring hemodialysis or stroke. ResultsThere were 106 CF LVADs, with 81 (76%) with no MAE and 25 with non-fatal MAEs (24%) within 30 days post-implant. There were no differences in baseline characteristics between those with and without MAE: age 55 years, male 84%, white 80%, ischemic 51%, mean duration of support 387 (SD) days. Likewise, there was no difference in device distribution between the two groups: HeartMate II 53%, HVAD 36%, VentrAssist 10%, Jarvik 1%. More patients with destination therapy (60%) than bridge to transplant (40%) had MAEs. Patients who experienced MAEs had significantly lower SF-36 scores at 1 month in two of eight domains: role physical (2.5 v. 12.8, p = 0.002) and vitality (27.0 v. 38.6, p = 0.04). There was also a trend towards worse physical functioning (20.2 v. 30.2, p = 0.06). At 3 months, physical functioning remained lower in those who had early MAEs (33.6 v. 50.3, p = 0.018), but the other domains were not significantly different. By 6 months, there were no significant differences between the SF-36 scores in any domain. There were 106 CF LVADs, with 81 (76%) with no MAE and 25 with non-fatal MAEs (24%) within 30 days post-implant. There were no differences in baseline characteristics between those with and without MAE: age 55 years, male 84%, white 80%, ischemic 51%, mean duration of support 387 (SD) days. Likewise, there was no difference in device distribution between the two groups: HeartMate II 53%, HVAD 36%, VentrAssist 10%, Jarvik 1%. More patients with destination therapy (60%) than bridge to transplant (40%) had MAEs. Patients who experienced MAEs had significantly lower SF-36 scores at 1 month in two of eight domains: role physical (2.5 v. 12.8, p = 0.002) and vitality (27.0 v. 38.6, p = 0.04). There was also a trend towards worse physical functioning (20.2 v. 30.2, p = 0.06). At 3 months, physical functioning remained lower in those who had early MAEs (33.6 v. 50.3, p = 0.018), but the other domains were not significantly different. By 6 months, there were no significant differences between the SF-36 scores in any domain. Conclusion