A Comparison of Quality-Adjusted Life Years in Older Adults after Heart Transplantation Versus Long-Term Mechanical Support: Findings from SUSTAIN-IT

PurposeThe Quality-Adjusted Life Year (QALY) is a measure of the burden of disease and its treatment that combines survival and health-related quality of life (HRQOL). We aim to describe QALYs in 3 groups of older patients (pts) (60-80 years) with heart failure (HF) who undergo heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or without pre-transplant MCS [HT Non-MCS]) or long-term MCS, if ineligible for HT.MethodsOf 396 pts enrolled in our study from 10/1/15 to 12/31/18 at 13 U.S. sites, 305 underwent HT (n=161: 68 HT MCS and 93 HT Non-MCS) or long-term MCS (n=144). Survival and HRQOL data were collected from date of HT or long-term MCS through 24 months (mos.) post-operatively. QALYs were calculated using health utilities derived from EQ-5D-3L dimensions and survival estimates per Kaplan-Meier method. Unadjusted comparisons of average QALY within 24 mos. of surgery among the 3 groups were based on t-tests; adjusted comparisons used log-linear models for restricted mean QALY estimates.ResultsPts were median age=66 years [IQR=63-70], 78% male, and 83% White. Beginning at 12 mos. after HT or long-term MCS, sustained significant differences in QALYs emerged across groups. At 24 mos., the unadjusted average QALY was significantly higher (p<0.001) in the HT Non-MCS group (22.8±0.5 mos.) and the HT MCS group (20.8±0.9 mos.) compared with the long-term MCS group (17.9±0.7 mos.), but was similar between the HT Non-MCS and HT MCS groups (p=0.076) (Table). After adjusting for age, gender, NYHA class, and # of co-morbidities, the average gain in QALY within 24 mos. remained significantly higher in the HT Non-MCS group (4.1±1.0 mos., p<0.001), but not in the HT MCS group (0.9±1.6 mos., p=0.66), compared with the long-term MCS group.ConclusionTwo-year QALYs were highest in the HT Non-MCS group as compared with the other two groups. This information may inform decision making for pts with HF considering advanced surgical therapies. The Quality-Adjusted Life Year (QALY) is a measure of the burden of disease and its treatment that combines survival and health-related quality of life (HRQOL). We aim to describe QALYs in 3 groups of older patients (pts) (60-80 years) with heart failure (HF) who undergo heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or without pre-transplant MCS [HT Non-MCS]) or long-term MCS, if ineligible for HT. Of 396 pts enrolled in our study from 10/1/15 to 12/31/18 at 13 U.S. sites, 305 underwent HT (n=161: 68 HT MCS and 93 HT Non-MCS) or long-term MCS (n=144). Survival and HRQOL data were collected from date of HT or long-term MCS through 24 months (mos.) post-operatively. QALYs were calculated using health utilities derived from EQ-5D-3L dimensions and survival estimates per Kaplan-Meier method. Unadjusted comparisons of average QALY within 24 mos. of surgery among the 3 groups were based on t-tests; adjusted comparisons used log-linear models for restricted mean QALY estimates. Pts were median age=66 years [IQR=63-70], 78% male, and 83% White. Beginning at 12 mos. after HT or long-term MCS, sustained significant differences in QALYs emerged across groups. At 24 mos., the unadjusted average QALY was significantly higher (p<0.001) in the HT Non-MCS group (22.8±0.5 mos.) and the HT MCS group (20.8±0.9 mos.) compared with the long-term MCS group (17.9±0.7 mos.), but was similar between the HT Non-MCS and HT MCS groups (p=0.076) (Table). After adjusting for age, gender, NYHA class, and # of co-morbidities, the average gain in QALY within 24 mos. remained significantly higher in the HT Non-MCS group (4.1±1.0 mos., p<0.001), but not in the HT MCS group (0.9±1.6 mos., p=0.66), compared with the long-term MCS group. Two-year QALYs were highest in the HT Non-MCS group as compared with the other two groups. This information may inform decision making for pts with HF considering advanced surgical therapies.