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Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation

BACKGROUND: The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. METHODS: We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was...

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Autores principales: Flint, Kelsey M., Spertus, John A., Tang, Fengming, Jones, Philip, Fendler, Timothy J., Allen, Larry A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348898/
https://www.ncbi.nlm.nih.gov/pubmed/28288574
http://dx.doi.org/10.1186/s12872-017-0510-9
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author Flint, Kelsey M.
Spertus, John A.
Tang, Fengming
Jones, Philip
Fendler, Timothy J.
Allen, Larry A.
author_facet Flint, Kelsey M.
Spertus, John A.
Tang, Fengming
Jones, Philip
Fendler, Timothy J.
Allen, Larry A.
author_sort Flint, Kelsey M.
collection PubMed
description BACKGROUND: The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. METHODS: We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured pre-operatively and 3 months post-LVAD using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol visual analog scale (VAS). Primary outcomes were mortality/rehospitalization. Inverse propensity weighting was used to minimize bias from missing data. RESULTS: Pre-operative global and heart failure-specific health status were very poor: KCCQ median 34.6 (IQR 21.4-50.5); VAS median 43 (interquartile range (IQR) 25–65). Health status measures improved 3 months after LVAD placement: KCCQ median 69.3 (IQR 54.2-82.3); VAS median 75 (IQR 60–85). Pre-operative health status was not associated with death (unadjusted HR for lowest vs. highest score quartiles: 1.09 (0.85-1.41) KCCQ; 1.12 (0.85-1.49) VAS) or rehospitalization (unadjusted HR 0.83 (0.72-0.96) KCCQ; 0.99 (0.85-1.16) VAS). Three-month KCCQ was associated with mortality (unadjusted HR 2.17 (1.47-3.21); VAS was not (1.43 (0.94-2.17). Three-month KCCQ added incremental discriminatory value to the HeartMate II Risk Score for death (c-stat 0.60 to 0.66); VAS did not (c-stat 0.59 to 0.60). Three-month health status was associated with rehospitalization (unadjusted HR 1.31 (1.15-1.57) KCCQ; 1.24 (1.05-1.46) VAS), but did not add incremental discriminatory value (c-stat 0.52 to 0.55 and 0.54, respectively). CONCLUSIONS: These real-world data suggest that pre-operative health status has limited association with outcomes after LVAD. However, persistently low health status after surgery may independently signal higher risk for subsequent death. Further study is needed to determine the clinical utility of routinely collected health status data after LVAD implantation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-017-0510-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-53488982017-03-14 Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation Flint, Kelsey M. Spertus, John A. Tang, Fengming Jones, Philip Fendler, Timothy J. Allen, Larry A. BMC Cardiovasc Disord Research Article BACKGROUND: The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. METHODS: We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured pre-operatively and 3 months post-LVAD using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol visual analog scale (VAS). Primary outcomes were mortality/rehospitalization. Inverse propensity weighting was used to minimize bias from missing data. RESULTS: Pre-operative global and heart failure-specific health status were very poor: KCCQ median 34.6 (IQR 21.4-50.5); VAS median 43 (interquartile range (IQR) 25–65). Health status measures improved 3 months after LVAD placement: KCCQ median 69.3 (IQR 54.2-82.3); VAS median 75 (IQR 60–85). Pre-operative health status was not associated with death (unadjusted HR for lowest vs. highest score quartiles: 1.09 (0.85-1.41) KCCQ; 1.12 (0.85-1.49) VAS) or rehospitalization (unadjusted HR 0.83 (0.72-0.96) KCCQ; 0.99 (0.85-1.16) VAS). Three-month KCCQ was associated with mortality (unadjusted HR 2.17 (1.47-3.21); VAS was not (1.43 (0.94-2.17). Three-month KCCQ added incremental discriminatory value to the HeartMate II Risk Score for death (c-stat 0.60 to 0.66); VAS did not (c-stat 0.59 to 0.60). Three-month health status was associated with rehospitalization (unadjusted HR 1.31 (1.15-1.57) KCCQ; 1.24 (1.05-1.46) VAS), but did not add incremental discriminatory value (c-stat 0.52 to 0.55 and 0.54, respectively). CONCLUSIONS: These real-world data suggest that pre-operative health status has limited association with outcomes after LVAD. However, persistently low health status after surgery may independently signal higher risk for subsequent death. Further study is needed to determine the clinical utility of routinely collected health status data after LVAD implantation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-017-0510-9) contains supplementary material, which is available to authorized users. BioMed Central 2017-03-14 /pmc/articles/PMC5348898/ /pubmed/28288574 http://dx.doi.org/10.1186/s12872-017-0510-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Flint, Kelsey M.
Spertus, John A.
Tang, Fengming
Jones, Philip
Fendler, Timothy J.
Allen, Larry A.
Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
title Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
title_full Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
title_fullStr Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
title_full_unstemmed Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
title_short Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
title_sort association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348898/
https://www.ncbi.nlm.nih.gov/pubmed/28288574
http://dx.doi.org/10.1186/s12872-017-0510-9
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