Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
J Heart Lung Transplant. 2022 Oct;41(10):1520-1528. doi: 10.1016/j.healun.2022.07.001. Epub 2022 Jul 8.
Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons' Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric.
Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire "KCCQ") incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant.
The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04).
Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.
左心室辅助装置（LVAD）植入后，健康相关生活质量（HRQOL）的改善是一个重要的结果。然而，胸外科医生协会 Intermacs 注册中心的一半植入前 HRQOL 数据是不完整的。植入前 HRQOL 不完整可能反映了患者的状态或医院获取 HRQOL 数据的资源。我们假设植入前 HRQOL 不完整预测 90 天的结果，并作为一种新的质量指标。
通过逐步逻辑模型检查植入前 HRQOL（EQ-5D-5L 视觉模拟量表；12 项堪萨斯城心肌病问卷“KCCQ”）不完整的危险因素。使用混合效应逻辑模型的直接标准化方法计算调整后不完整率。根据调整后不完整率的中位数，将医院分为低或高两类。使用 Andersen-Gill 模型将植入前 HRQOL 调整后不完整率与植入后 90 天内的不良事件相关联。
该研究队列包括 14063 名接受原发性 LVAD 治疗的患者（2012 年 4 月至 2017 年 8 月）。高比率医院的 HRQOL 不完整通常是由于行政原因（风险差异，EQ-5D：10.1%；KCCQ-12：11.6%），而不是由于患者原因（风险差异，EQ-5D：-8.9%；KCCQ-12：-11.4%）。植入前调整后的 EQ-5D 不完整率每增加 10%，与感染相关死亡率（HR：1.09）、感染（HR：1.05）和肾功能障碍（HR：1.03）的风险增加显著相关。植入前调整后的 KCCQ-12 不完整率每增加 10%，与感染的风险增加显著相关（HR：1.04）。
医院调整后的植入前 HRQOL 不完整与 90 天后的植入结果相关，可作为一种新的质量指标。
