Predictors of changes in health status between and within patients 12months post left ventricular assist device implantation

Background Improving patient-reported outcomes (e.g. health status) has become an important goal in left ventricular assist device (LVAD) therapy, in addition to reducing mortality and morbidity. We examined predictors of changes in health status scores between and within patients 12months post LVAD implantation. Methods Health status [Kansas City Cardiomyopathy Questionnaire (KCCQ); Short-Form 12 (SF-12)] were assessed at 3-4weeks after implantation, and at 3, 6 and 12months follow up in 54 LVAD patients (74% men; mean age 54±9years). Results Patients experienced significant improvements in health status between baseline and 3months follow-up as assessed by the KCCQ (clinical summary score: F=33.49, P<0.001; overall summary score: F=31.13, P<0.001) and the SF-12 (physical component score: F=31.59, P<0.001; mental component score: F=21.77, P<0.001), but not between 3months and 12months follow-up (P>0.05 for all). Higher scores on anxiety and depression over time, older age, lower ejection fraction, and more co-morbidity were associated with poorer health status scores on one or both of the KCCQ and SF-12 subscales. The majority of the between-patient variance of the mental component summary scores (82.6%), but not the KCCQ overall summary score (41.9%), KCCQ clinical summary score (36.2%) and physical component summary scores (23.2%), was explained by the sociodemographic, clinical and psychological factors. Conclusion The majority of LVAD patients show a significant improvement in health status after LVAD implantation. However, there are large differences in individual health status score trajectories which are only partly explained by measures of disease severity pre-LVAD, co-morbidity and psychological stress.

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