PurposeWe sought to identify factors associated with long-term changes in health-related quality of life (HRQOL) among 3 groups of older patients (pts) with advanced heart failure (HF) undergoing heart transplantation (HT), with or without pre-transplant mechanical circulatory support (MCS), or long-term MCS, if ineligible for HT.MethodsFrom 10/1/15-12/31/18, 393 pts (60-80 years) were enrolled from 13 U.S. sites, including 239 pts awaiting HT (118 with and 121 without MCS) and 154 long-term MCS pts. Of these, 151 pts (95 HT pts [34 with MCS and 61 without MCS before HT] and 56 long-term MCS pts) had 24-month follow-up data. The EQ-5D Visual Analog Scale (VAS; 0-100 [worst-best health state]) and KCCQ-12 overall summary score (OSS; 0-100 [poor-excellent health status]) were collected at baseline (closest to surgery) and 24-months. Analyses included ANOVA, paired t-tests, and multivariable linear regression.ResultsAverage age at HT or long-term MCS implant (n=151) was 66.8 ±4.5 years, 80% were male, and 81% were white. At baseline, long-term MCS pts, compared with HT pts awaiting HT with MCS and those awaiting HT on medical therapy, had the lowest VAS scores (48.7±20.8 vs 65.9±21.0 vs 51.6±25.4, p=0.002) and KCCQ-12 OSS (37.1±20.9 vs 56.5±25.6 vs 46.4±20.5, p<0.001). HRQOL improved significantly in all 3 groups by 24 months (p<0.001); however, long-term MCS pts, compared with HT pts awaiting HT with MCS and those awaiting HT on medical therapy, still had the lowest VAS scores (70.9±19.7 vs 81.8±14.6 vs 86.2±12.1, p<0.001) and KCCQ-12 OSS (63.3±24.1 vs 85.3±16.0 vs 90.0±14.3, p<0.001). Multivariable models (Table) indicate that baseline HRQOL and undergoing HT, with or without MCS, are the strongest predictors of improvement in HRQOL.ConclusionAmong pts with advanced HF requiring HT or MCS, improvement in HRQOL was greatest in those undergoing HT with or without MCS pre-HT and those with worse baseline HRQOL. These findings may inform advanced HF pts of anticipated HRQOL outcomes with alternative therapies. We sought to identify factors associated with long-term changes in health-related quality of life (HRQOL) among 3 groups of older patients (pts) with advanced heart failure (HF) undergoing heart transplantation (HT), with or without pre-transplant mechanical circulatory support (MCS), or long-term MCS, if ineligible for HT. From 10/1/15-12/31/18, 393 pts (60-80 years) were enrolled from 13 U.S. sites, including 239 pts awaiting HT (118 with and 121 without MCS) and 154 long-term MCS pts. Of these, 151 pts (95 HT pts [34 with MCS and 61 without MCS before HT] and 56 long-term MCS pts) had 24-month follow-up data. The EQ-5D Visual Analog Scale (VAS; 0-100 [worst-best health state]) and KCCQ-12 overall summary score (OSS; 0-100 [poor-excellent health status]) were collected at baseline (closest to surgery) and 24-months. Analyses included ANOVA, paired t-tests, and multivariable linear regression. Average age at HT or long-term MCS implant (n=151) was 66.8 ±4.5 years, 80% were male, and 81% were white. At baseline, long-term MCS pts, compared with HT pts awaiting HT with MCS and those awaiting HT on medical therapy, had the lowest VAS scores (48.7±20.8 vs 65.9±21.0 vs 51.6±25.4, p=0.002) and KCCQ-12 OSS (37.1±20.9 vs 56.5±25.6 vs 46.4±20.5, p<0.001). HRQOL improved significantly in all 3 groups by 24 months (p<0.001); however, long-term MCS pts, compared with HT pts awaiting HT with MCS and those awaiting HT on medical therapy, still had the lowest VAS scores (70.9±19.7 vs 81.8±14.6 vs 86.2±12.1, p<0.001) and KCCQ-12 OSS (63.3±24.1 vs 85.3±16.0 vs 90.0±14.3, p<0.001). Multivariable models (Table) indicate that baseline HRQOL and undergoing HT, with or without MCS, are the strongest predictors of improvement in HRQOL. Among pts with advanced HF requiring HT or MCS, improvement in HRQOL was greatest in those undergoing HT with or without MCS pre-HT and those with worse baseline HRQOL. These findings may inform advanced HF pts of anticipated HRQOL outcomes with alternative therapies.
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