650 Quality of life of patients with end stage heart failure treated with left ventricular assist devices

Abstract

Aims: Nowadays continuous flow left ventricular assist devices (LVAD) have become a reality for patients with end-stage heart failure (HF) who are failing maximal medical treatment, both eligible or not for heart transplantation. LVADs have demonstrated to improve functional capacity and clinical outcomes, including breathing and activity tolerance, but the impact on patients quality of life (QoL) is still a vexed and open question. Moreover, the device implantation actually requires significant life style changes, high motivation and adherence to treatment, both for patients and their caregivers. Patients must learn to live with the device and to interface with the controller and batteries system, adjusting everyday life's activities to the device presence. The purpose of our study is to evaluate how the implantation of HeartMate 3TM impact on patients-related QoL and clinical outcomes, compared with general population and other chronic diseases. Methods and Results: Eight patients (pts) with a diagnosis of end-stage HF were implanted with the HeartMate 3TM LVAD from May 2017 to October 2019 in the Cardiac Surgery Unit of Brotzu Hospital. During a follow-up visit (28.7+/-11.9 months after surgery), the 7 pts presenting were assessed with two questionnaires, the SF-12 and EuroQoL-5D, in order to evaluate improvement of quality of life compared with clinical presentation. Afterwards we compared the average SF-12 total result with 28 controls from general population and with other important chronic diseases. The analysis of SF-12 questionnaires showed an average of 28.00+/-8.98 (VN: 12-47) as total score, 11.7+/-3.4 (VN: 6-20) as physical health component score and 16.2+/-6.5 (VN: 6-27) as mental health component score. These findings, though within the range of 'normality', are closer to the lower scores and show the negative impact of LVAD in everyday patients-related quality of life. Comparing the NYHA functional class with these results, we found a statistically significant negative linear correlation for both total (-0.80, P=0.03) and mental health component scores (-0.75, P=0.049). Average total score of our pts significatively differs compared with 28 controls of general population (28.00+/-8.98 vs. 38.64+/-6.80, P=0.014), as well as compared with other chronic diseases like Wilson's disease (P<0.001), celiac disease (P<0.001), obsessive-compulsive disorder (P<0.001), panic disorder (P<0.001), major depressive disorder (P=0.009), multiple sclerosis (P<0.011), food disorders (P=0.023), and carotid atherosclerosis (P=0.049). The EuroQoL-5D questionnaire investigates five particular 'dimensions' of the subjectively perceived health-related quality of life (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and shows similar. We found a poor average score at Visual Analogue Scale (58.5+/-18.86) and a statistically significant negative linear correlation with NYHA functional class (-0.76, P=0.046). The 42.86% referred no pain or discomfort and in the other four dimensions most of them reported 'moderate limitations', both physical or mental, especially for self-care domain (85.71%), as inevitable result of the device's size. Conclusion(s): LVAD can improve clinical outcomes and functional capacity of carefully select pts with end-stage HF, but the complications encountered during mechanical support and the lifestyle changes required can affect negatively patients well-being. Many studies have shown that most patients experience significant improvement even in QoL's perception but for others the device have a negative impact on many aspects of normal daily living as well as emotional, mental and social functioning. Our study confirms this conflicting results: physical related-quality of life improves after LVAD implantation but emotional and psychological distress may persist, especially during long-term support, as a result of complications, co-morbidities and personal's attitudes, values and way of life.