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Ann Thorac Surg 2004;77:1321-1327
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation

^a Rush University Medical Center, Chicago, Illinois, USA
^b St. Luke's Medical Center, Milwaukee, Wisconsin, USA
^c Sharp Memorial Hospital, San Diego, California, USA
^d University of Pennsylvania, Philadelphia, Pennsylvania, USA
^e University of Alabama, Birmingham, Alabama, USA
^f Temple University, Philadelphia, Pennsylvania, USA
^g University of Minnesota, Minneapolis, Minnesota, USA
^h St. Vincent's Hospital, Darlinghurst, Australia

Accepted for publication September 22, 2003.

^* Address reprint requests to Dr Grady, Section of Cardiology, Rush Heart Failure and Cardiac Transplant Program, Rush University Medical Center, 1725 West Harrison, Suite 439, Chicago, IL, USA 60612-3824
e-mail: kgrady{at}rush.edu

BACKGROUND: The HeartMate vented electric left ventricular assist device has been approved for use as destination therapy. Thus, the study of quality-of-life outcomes, as well as morbidity and mortality, is imperative. The purpose of our study was to describe change with time (from 1 month to 1 year) in patients who received a HeartMate vented electric left ventricular assist device as a bridge to heart transplantation and to identify quality-of-life predictors of survival after left ventricular assist device implantation.

METHODS: A nonrandom sample of 78 patients who received a HeartMate vented electric left ventricular assist device (primarily middle-aged, white married males) who had quality-of-life data at 1, 2, 3, 6, 9, or 12 months after implant was the subject of this report. The sample size decreased with time primarily because of heart transplantation. Patients completed the following booklets of questionnaires: Quality of Life Index, Rating Question Form, Heart Failure Symptom Checklist, and Sickness Impact Profile. Analyses included both descriptive analyses and modeling procedures (mixed-effects models and Cox proportional hazards models).

RESULTS: Quality-of-life outcomes were fairly good and stable from 1 month to 1 year after HeartMate vented electric left ventricular assist device implantation. Both positive and negative changes were detected in all quality-of-life domains (physical and occupational function, social interaction, somatic sensation, and psychological state) after left ventricular assist device insertion. Items from the physical domain of quality of life, specifically walking and dressing oneself, were significantly associated with the risk of dying after left ventricular assist device implantation.

CONCLUSIONS: Identifying poor quality-of-life outcomes within 1 year after left ventricular assist device implantation provides direction to develop strategies to improve outcomes. Physical and occupational rehabilitation, psychosocial intervention, and monitoring symptom distress and physical disability may contribute to improved quality-of-life outcomes and survival after left ventricular assist device implantation.

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