Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA; University of Missouri--Kansas City, Kansas City, Missouri, USA.
Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA; Department of Medicine, Division of Cardiology, Section of Advanced Heart Failure and Transplantation, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA.
J Heart Lung Transplant. 2017 Nov;36(11):1243-1249. doi: 10.1016/j.healun.2017.05.023. Epub 2017 May 20.
Quantifying quality of life (QoL) after left ventricular assist device (LVAD) remains challenging. Heart failure (HF)-specific health status measures are ideal for assessing symptoms of HF; however, if patients' QoL is limited by other factors, they may experience improved HF-specific QoL but no concurrent improvement in generic QoL. We sought to examine and predict discrepancies between disease-specific and generic QoL measures after LVAD.
We examined HF-specific and generic QoL with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol-5D Visual Analog Scale (VAS), respectively, among 1,888 patients with advanced heart failure who underwent LVAD implantation from 2012 to 2014 as part of the INTERMACS registry.
Both measures showed substantial improvement, on average, at 6 months after LVAD, with mean changes of 32.7 ± 25.0 and 27.6 ± 27.4, respectively. Among the 1,539 patients (81.5%) with moderate/large improvement in KCCQ, 334 (21.7%) had discordant changes in generic QoL (i.e., VAS did not substantially increase despite improvement in KCCQ). In a multivariable logistic regression model, baseline VAS score was the strongest predictor of KCCQ-VAS discordance, whereas post-LVAD complications were not significant predictors of discordance.
Most patients have major improvements in both HF-specific and generic QoL after LVAD implantation, and discordance in these measures after LVAD is uncommon. When it did occur, discordance was primarily observed in patients who reported good generic QoL on the VAS before LVAD (despite substantial impairment due to congestive HF). These results support the continued use of HF-specific health status measures to monitor QoL before and after LVAD implantation.
量化左心室辅助装置 (LVAD) 后的生活质量 (QoL) 仍然具有挑战性。心力衰竭 (HF) 特异性健康状况衡量标准最适合评估 HF 症状；然而，如果患者的 QoL 受到其他因素的限制，他们可能会经历 HF 特异性 QoL 的改善，但通用 QoL 没有同时改善。我们试图检查并预测 LVAD 后疾病特异性和通用 QoL 测量之间的差异。
我们检查了心力衰竭特异性和通用 QoL，分别使用堪萨斯城心肌病问卷 (KCCQ) 和 EuroQol-5D 视觉模拟量表 (VAS)，其中包括 2012 年至 2014 年间接受 LVAD 植入的 1888 名晚期心力衰竭患者，这些患者是 INTERMACS 登记处的一部分。
两种测量方法在 LVAD 后 6 个月平均均有显著改善，分别为 32.7±25.0 和 27.6±27.4。在 KCCQ 中度/大幅度改善的 1539 名患者 (81.5%)中，有 334 名 (21.7%)的通用 QoL 变化不一致(即，尽管 KCCQ 改善，但 VAS 没有大幅增加)。在多变量逻辑回归模型中，基线 VAS 评分是 KCCQ-VAS 不一致的最强预测因子，而 LVAD 后并发症不是不一致的显著预测因子。
大多数患者在 LVAD 植入后 HF 特异性和通用 QoL 都有显著改善，LVAD 后这些测量方法的不一致并不常见。当不一致确实发生时，主要观察到那些在 LVAD 前 VAS 报告通用 QoL 良好的患者(尽管由于充血性 HF 而存在实质性损害)。这些结果支持在 LVAD 植入前后继续使用 HF 特异性健康状况衡量标准来监测 QoL。
