Original clinical science
Health-related quality of life and exercise tolerance in recipients of heart transplants and left ventricular assist devices: A prospective, comparative study

https://doi.org/10.1016/j.healun.2010.08.030Get rights and content

Background

The aim of this study was to evaluate and compare health-related quality of life (HRQoL) and physical exercise tolerance in patients after heart transplantation (HTx) or implantation of a left ventricular assist device (LVAD).

Methods

A prospective, comparative design was used to characterize changes over time in HRQoL (SF-36) and exercise tolerance in patients after HTx (n = 54) and during LVAD support (n = 36). Nine LVAD patients were lost for follow-up. The majority of patients in both groups were male (97%); the LVAD cohort tended to be younger (p = 0.06).

Results

HRQoL improved significantly in HTx patients in the SF-36 physical (p = 0.02), but not in the psychosocial (p = 0.27) component score during follow-up. In the LVAD group, HRQoL showed improvements for both the SF-36 physical and psychosocial component scores (both p = 0.04). Between-group comparisons revealed better HRQoL for the HTx cohort than the LVAD cohort for 2 of 8 SF-36 subscales. Age-, gender- and body mass index (BMI)-adjusted exercise tolerance (workload; VO2max) showed significant improvements for both HTx (p = 0.01) and LVAD (p = 0.01) patients. Adjusted maximum oxygen consumption was higher for HTx patients (p = 0.05) relative to LVAD patients at 8 ± 1 months after implant.

Conclusion

HRQoL and exercise capacity increased in both groups over the time-course of the study. After adjusting for relevant variables, HTx patients showed a higher exercise tolerance compared with the LVAD group during follow-up. Thus, future large-scale intervention studies should emphasize the specific needs of these patient cohorts.

Section snippets

Design

A prospective, observational, repeated-measures design was chosen to characterize changes over time that occur in HRQoL and exercise tolerance adjustment in patients after HTx and in those on LVAD support immediately after transplantation or implantation surgery. Changes in functional and psychosocial outcome parameters in 54 HTx patients were compared with those of 36 LVAD patients. HRQoL-related subgroup comparisons were performed with age- and gender-matched normative data27 for the German

Health-related quality of life

The Medical Outcomes Study Short-Form General Health Survey (SF-36) illustrates physical and psychosocial functioning and includes multiple-item scales to measure the following 8 health-related aspects: physical function (PF); role-physical (RP); bodily pain (BP); general health perceptions (GH); vitality (VITA); social function (SF); role-emotional (RE); and mental health (MH).27, 30 The score for each of the 8 health concepts ranges from 0 to 100, with higher scores indicating better

Sample

A total of 90 patients who met the study entry criteria were enrolled and underwent baseline assessment (T1) after successful transplant or implant procedures. Patients were predominantly male and there was a trend for the HTx group patients to be older (52 ± 12 years) than LVAD group patients (47 ± 13 years) (p = 0.06). During the follow-up period, 2 patients in the LVAD group died due to hemorrhagic events. The majority of LVAD patients were still on device support at follow-up (T2). Further

Discussion

To our knowledge, this is the first report prospectively comparing patient outcomes after HTx with those on LVAD support in terms of patients' self-reported QoL. Patients' self-ratings were supplemented by cardiopulmonary exercise testing. Overall, our results indicate that patients benefited from both surgical treatment procedures, as suggested by the relatively stable HRQoL ratings during the study period. These findings are confirmed by a longitudinal multisite trial provided by Grady et al.9

Disclosure statement

This study was supported in part by grants from the German Foundation of Heart Research (F/05/08) and the German Federal Ministry of Education and Research (01EO0802).

M.S. is a member of the European Advisory Board Thoratec, Inc. None of the other authors have any conflicts of interest to disclose.

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