Measurement of Quality of Life with LVAD Destination Therapy

Objective: Left ventricular assist device (LVAD) destination therapy (DT) is a widely accepted standard in non-transplantable heart failure patients. However, the gain of quality of life (QOL) with this therapy is not fully evaluated. We studied the QOL in LVAD DT patients pre- and post-LVAD therapy.

Methods: All patients with elective and urgent LVAD-DT implantation (INTERMACS 2–5) were evaluated pre- and postoperatively with two QOL questionnaires. The EQ-5D-5L of the EuroQol Group and the Nürnberger QOL Questionnaire (NLQ,) were used. The EQ-5D-5L is a standardized measure of health status for clinical and economic appraisal. It has a descriptive system and a visual analogue scale (EQ VAS from 0 to 100). The NLQ is standardized measure of QOL with 39 questions in 4 dimensions. Preoperative questioning was performed either ambulatory or in the hospital. All postoperative questioning was performed ambulatory.

Results: 35 pts. were evaluated with the test battery in average 10.9 ± 14.3 days pre and 22.6 ± 20.3 month (range, 1.2 month–6.1 years) post-LVAD-DT. Average age was 67 ± 8 years, 87% male, 80% ischemic cardiomyopathy. The values of the EQ-5D-5L is seen in Fig. 1. Mobility, usual activities and anxiety could be significantly improved with LVAD-DT therapy. Similar the EQ-VAS and the NLQ showed in all items a significant improvement with LVAD-DT (Fig. 1). All items were steady over time of LVAD-DT.

Conclusion: QOL in non-transplantable heart failure patients is worse. LVAD-DT leads to a significant improvement in health status and quality of life shortly after implantation and is persistent over time.

Fig. 1 Sig. decrease in the EQ-5D-5L except Self care and Pain (top, lower value = better QOL) and significant increase in all dimensions in EQ VAS and NLQ (bottom, higher value = better QOL).