Trends in Health-Related Quality of Life Among Patients With Advanced Heart Failure

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.

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