Establishing and understanding patients’ health-related quality of life (HRQOL) may improve decision making when considering heart transplant or long-term mechanical circulatory support (MCS). These findings were published in Journal of the American Heart Association.

The Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support (SUSTAIN-IT; Clinicaltrials.gov identifier: NCT02568930) study recruited patients (N=393) with advanced heart failure (HF) from 13 centers in the United States between 2015 and 2018. Patients considering heart transplant (n=239) or long-term MCS (n=154) were assessed for HRQOL by the EuroQol-5 Dimension Questionnaire (EQ-5D-3L) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) and underwent a physical evaluation.

Most patients were married White men who had more than a high school education. Heart transplant candidates were younger, had fewer comorbidities, and lower New York Heart Association (NYHA) class ratings than the MCS candidates.


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HRQOL was poor to fair overall at baseline with more than half of patients reporting pain or discomfort and difficulties with mobility and usual activities. The average EQ-5D-3L score was 55±23 and KCCQ-12 score was 47±23.

The heart transplant cohort had higher EQ-5D-3L (mean, 68 vs 46; P <.001) and KCCQ-12 (mean, 60 vs 35; P <.001) scores than the MCS group, respectively. Overall, MCS candidates had more difficulties with mobility, usual activities, self-care, and anxiety or depression.

Heart transplant candidates who were receiving MCS were associated with an 8.6-point (P =.004) increase in EQ-5D-3L scores compared with candidates not receiving MCS.

A third of the variance in EQ-5D-37 score (33%) was explained by decreased 6-minute walk test distance, increased depressive symptoms, and treatment group. Most of the variance in KCCQ-12 score (58%) was explained by decreased 6-minute walk test distance, increased depressive symptoms, and increased NYHA class rating.

This study was limited by not including a post-intervention follow-up; however, that analysis is planned.

“These findings demonstrate important differences in overall and domain-specific HRQOL of older patients with advanced HF before [heart transplant] or long-term MCS,” the study authors wrote. “Understanding differences in HRQOL may guide decisions toward more personalized, advanced HF therapies.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Grady KL, Andrei A-C, Elenbaas C, et al. Health-related quality of life in older patients with advanced heart failure: Findings from the SUSTAIN-IT Study. J Am Heart Assoc. Published online February 12, 2022. doi:10.1161/JAHA.121.024385