Pre-operative health status and outcomes after continuous-flow Left ventricular assist device implantation

BACKGROUND: Health status predicts adverse outcomes in heart failure and cardiac surgery patients, but its prognostic value in left ventricular assist device (LVAD) placement is unknown. METHODS: We examined the association of pre-operative health status, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), with survival and hospitalization after LVAD using the KCCQ score as a continuous variable and stratified by KCCQ score quartile plus missing KCCQ in 1,125 clinical trial participants who received the HeartMate II (Thoratec Corp, Pleasanton, CA) as destination therapy (n = 635) or bridge to transplantation (n = 490). RESULTS: The mean pre-operative KCCQ score was 29.4 +/- 18.7 among survivors (n = 719), and 27.1 +/- 18.3 (n = 406) in those who died. In time-to-event analysis for all available follow-up using health status as a continuous variable, the pre-operative KCCQ score did not correlate with overall mortality after LVAD implantation (p = 0.178). Small absolute differences were seen between the pre-operative KCCQ quartile and 30-day survival (Q4 95% vs Q1 89% vs missing 87%; p = 0.0009 for trend), 180-day survival (Q4 83% vs Q1 76% vs missing 79%; p = 0.060 for trend), and days hospitalized at 180 days (Q4 29.8 +/- 25.6 vs Q1 34.1 +/- 27.1 vs missing 36.5 +/- 29.9 days; p = 0.009 for trend). CONCLUSION: Our findings suggest that pre-operative health status has limited association with outcomes after LVAD implantation. Although these data require further study in a diverse population, mechanical circulatory support may represent a relatively unique clinical situation, distinct from heart failure and other cardiac surgeries, in which heart failure-specific health status measures may be largely (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.