Health-Related Quality of Life in Older Patients With Advanced Heart Failure From Before to 2 Years After Heart Transplantation or Long-Term Mechanical Circulatory Support: Findings From the SUSTAIN-IT Study

BACKGROUND: Health-related quality of life (HRQOL) is a key consideration among older patients with heart failure considering advanced therapies. We evaluated change in HRQOL from before to 24 months after heart transplantation (HT) or long-term mechanical circulatory support (MCS) among older (60–80 years) patients and identified factors associated with HRQOL changes. METHODS: Data for this observational study were collected from 13 US sites via patient self-reported measures (EuroQol-5-dimension-3L visual analog scale score: 0=worst–100=best imaginable health state and dimension scores; Kansas City Cardiomyopathy Questionnaire-12 overall summary score/domain scores: 0–100, higher=better health status; other measures) and a 6-minute walk test. Analyses included multivariable linear mixed-effects models. RESULTS: Of 393 enrollees, 305 underwent surgery: HT with pretransplant MCS (HT MCS)=69, HT without pretransplant MCS (HT non-MCS)=92, and long-term MCS=144. Cohort average age=66.9±4.7 years, 78% male, 83% White, 78% married/partnered, and 71% with >high school education. HT non-MCS and long-term MCS groups experienced significant improvement in average visual analog scale scores within 6 months after surgery, sustained through 24 months of follow-up; the HT MCS group EuroQol-5-dimension-3L baseline visual analog scale score was higher than those of the other 2 groups and did not improve significantly through 24 months of follow-up. The average Kansas City Cardiomyopathy Questionnaire-12 overall summary score improved in all 3 groups (baseline–6 months, sustained through 24 months). Compared with HT non-MCS, the main effect of long-term MCS showed decrements of −11.2 (−17.3 to −5.1; P <0.001) points in Kansas City Cardiomyopathy Questionnaire-12 overall summary score and of −9.9 (−16.1 to −3.8; P =0.002) points in EuroQol-5-dimension-3L visual analog scale. CONCLUSIONS: HT MCS improvement in HRQOL varied by measure; HT non-MCS and long-term MCS improvement occurred through 24 months, regardless of measure. Domains of HRQOL improved after these surgeries, varying by surgical strategy and postoperative time period. Long-term MCS was associated with a decrease in HRQOL across time. These findings provide important information for patients considering treatment options.