Quality of life after heart transplantation: are things really better?

Studies of quality of life (QOL) in heart transplant recipients have been published during the last 2 decades. More recent studies of QOL outcomes have built on previous research. Relationships between posttransplant complications and QOL, longitudinal studies of intermediate and long-term QOL, QOL in patients awaiting transplant (bridged to transplant with a left ventricular assist device), and intervention studies to improve QOL have been published recently. Is QOL better from before to after heart transplantation? The current body of literature suggests that QOL is better overall. However, change in QOL (both positive and negative) is variable based on demographic characteristics, clinical problems, QOL domain, time posttransplant, and other life events. Moreover, although more recent reports have begun to examine unanswered questions, much work remains to be done. Future studies need to be scientifically rigorous, using definitions of QOL with identification of domains to be studied; prospective, multisite, longitudinal study designs; large sample sizes; reliable and valid instruments; and appropriate statistical techniques. As changes in QOL outcomes and risks for poor QOL outcomes are identified, more intervention studies need to be developed to assist patients toward better QOL.