Title

Health-related quality of life in older patients with advanced heart failure: Findings from the SUSTAIN-IT study

Authors

Kathleen L. Grady, Department of Surgery Northwestern University Chicago IL.
Adin-Cristian Andrei, Department of Preventive Medicine Northwestern University Chicago IL.
Christian Elenbaas, Department of Surgery Northwestern University Chicago IL.
Anna Warzecha, Department of Surgery Northwestern University Chicago IL.
Abigail Baldridge, Department of Surgery Northwestern University Chicago IL.
Andrew Kao, Department of Medicine St. Luke's Medical Center Kansas City MO.
John A. Spertus, Department of Medicine University of Missouri-Kansas City Kansas City MO.
Duc-Thinh Pham, Department of Surgery Northwestern University Chicago IL.
Mary Amanda Dew, Department of Psychiatry University of Pittsburgh Pittsburgh PA.
Eileen Hsich, Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH.
William Cotts, Advocate Aurora HealthFollow
Justin Hartupee, Department of Medicine Washington University St. Louis MO.
Salpy V. Pamboukian, Department of Medicine University of Alabama-Birmingham Birmingham AL.
Francis D. Pagani, Department of Cardiac Surgery University of Michigan Ann Arbor MI.
Michael Petty, Department of Nursing University of Minnesota Medical Center Minneapolis MN.
Brent Lampert, Department of Internal Medicine Ohio State University Columbus OH.
Maryl Johnson, Department of Medicine University of Wisconsin Madison WI.
Margaret Murray, University of Wisconsin Hospitals and ClinicsUniversity of Wisconsin Madison WI.
Koji Takeda, Department of Surgery Columbia University New York NY.
Melana Yuzefpolskaya, Department of Medicine Columbia University New York NY.
Scott Silvestry, AdventHealth Transplant Institute Florida Hospital Orlando FL.
James K. Kirklin, Department of Surgery University of Alabama-Birmingham Birmingham AL.
Clyde Yancy, Department of Medicine Northwestern University Chicago IL.

Affiliations

Advocate Heart Institute, Advocate Christ Medical Center

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, χ 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 [<0.001] and Kansas City Cardiomyopathy Questionnaire-12 overall summary scores, 35±21 versus 60±21 versus 49±22 [<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.

Document Type

Article

PubMed ID

35156421


 

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