TY - JOUR
T1 - Both Patient and Caregiver Factors are Related to Patient Health-Related Quality of Life before Surgery
AU - Grady, K. L.
AU - Xu, Y.
AU - Andrei, A.
AU - Warzecha, A.
AU - Kao, A.
AU - Hsich, E. M.
AU - Dew, M.
AU - Kormos, R. L.
AU - Pham, D.
AU - LaRue, S.
AU - Petty, M. G.
AU - Cotts, W. G.
AU - Pamboukian, S. V.
AU - Pagani, F. D.
AU - Lampert, B. C.
AU - Johnson, M. R.
AU - Murray, M. A.
AU - Tekeda, K.
AU - Yuzefpolskaya, M.
AU - Silvestry, S.
AU - Spertus, J.
AU - Kirklin, J. K.
AU - Collum, S.
AU - Yancy, C. W.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - PURPOSE: Factors related to health-related quality of life (HRQOL) of older patients (pts) with advanced heart failure (HF) scheduled for left ventricular assist device (LVAD) implantation as destination therapy (DT) or while a candidate for heart transplantation (HT) with or without an LVAD, may guide therapeutic strategies. We sought to identify pt and caregiver (cg) factors related to HRQOL of pts (60-80 years) awaiting these surgeries. METHODS: From 10/1/15-12/31/18, we enrolled 302 pts with cgs (n=302) from 13 U.S. sites: 193 pts awaiting HT (92 with and 101 without LVAD) and 109 DT LVAD pts. Pts completed the EQ-5D-3L Visual Analog Scale (VAS): 0-100 (worst-best) health; KCCQ-12 summary score (SS), 0-100=low-high; PHQ-8 (0-24; score >10=significant depressive symptoms) and STAI-state (20-80; higher score=more anxiety). Cgs completed the EQ-5D, STAI, PHQ-8 and Oberst Caregiving Burden Scale (OCBS): 2 subscales (time and difficulty, 1-5; higher score=more time and more task difficulty). Analyses included multivariable logistic regression models; the binary outcomes were whether individual EQ-5D VAS and KCCQ-12 SSs were higher than the cohort median of 60 and 46, respectively. RESULTS: Pts were 66.1±4.5 years, 82% male, and 86% white. Pts reported relatively low generic HRQOL (VAS mean=55.3±23.5) and low HF-specific HRQOL (SS mean=47.5±22.5), both with significant group differences. HT pts with LVADs were more likely to have higher EQ-5D VAS scores; DT pts had the lowest VAS scores (p< 0.001). PHQ-8 >10 was related to lower VAS scores (p< 0.001). HT pts with LVADs were more likely to have a higher KCCQ-12 SS, DT pts had the lowest score (p< 0.001), and PHQ-8>10 was related to lower KCCQ-12 SSs (p< 0.001). Pts whose cgs spent the most time caregiving (top quartile) had lower KCCQ-12 SSs (OR = 0.45, p=0.002) (table). CONCLUSION: Implant strategy, pt depression, and cg time spent on care were significantly related to older advanced HF pt HRQOL. Findings may inform interventions for HF pts awaiting surgery.
AB - PURPOSE: Factors related to health-related quality of life (HRQOL) of older patients (pts) with advanced heart failure (HF) scheduled for left ventricular assist device (LVAD) implantation as destination therapy (DT) or while a candidate for heart transplantation (HT) with or without an LVAD, may guide therapeutic strategies. We sought to identify pt and caregiver (cg) factors related to HRQOL of pts (60-80 years) awaiting these surgeries. METHODS: From 10/1/15-12/31/18, we enrolled 302 pts with cgs (n=302) from 13 U.S. sites: 193 pts awaiting HT (92 with and 101 without LVAD) and 109 DT LVAD pts. Pts completed the EQ-5D-3L Visual Analog Scale (VAS): 0-100 (worst-best) health; KCCQ-12 summary score (SS), 0-100=low-high; PHQ-8 (0-24; score >10=significant depressive symptoms) and STAI-state (20-80; higher score=more anxiety). Cgs completed the EQ-5D, STAI, PHQ-8 and Oberst Caregiving Burden Scale (OCBS): 2 subscales (time and difficulty, 1-5; higher score=more time and more task difficulty). Analyses included multivariable logistic regression models; the binary outcomes were whether individual EQ-5D VAS and KCCQ-12 SSs were higher than the cohort median of 60 and 46, respectively. RESULTS: Pts were 66.1±4.5 years, 82% male, and 86% white. Pts reported relatively low generic HRQOL (VAS mean=55.3±23.5) and low HF-specific HRQOL (SS mean=47.5±22.5), both with significant group differences. HT pts with LVADs were more likely to have higher EQ-5D VAS scores; DT pts had the lowest VAS scores (p< 0.001). PHQ-8 >10 was related to lower VAS scores (p< 0.001). HT pts with LVADs were more likely to have a higher KCCQ-12 SS, DT pts had the lowest score (p< 0.001), and PHQ-8>10 was related to lower KCCQ-12 SSs (p< 0.001). Pts whose cgs spent the most time caregiving (top quartile) had lower KCCQ-12 SSs (OR = 0.45, p=0.002) (table). CONCLUSION: Implant strategy, pt depression, and cg time spent on care were significantly related to older advanced HF pt HRQOL. Findings may inform interventions for HF pts awaiting surgery.
UR - https://www.scopus.com/pages/publications/85085676073
U2 - 10.1016/j.healun.2020.01.933
DO - 10.1016/j.healun.2020.01.933
M3 - Article
C2 - 32466065
AN - SCOPUS:85085676073
SN - 1053-2498
VL - 39
SP - S92-S93
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 4
ER -