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Quality of life with an implanted left ventricular assist device
A J Moskowitz1, A D Weinberg, M C Oz
1Department of Surgery, School of Public Health, Columbia University, College of Physicians & Surgeons, and The Presbyterian Hospital, New York, New York, USA. ajm4@columbia.edu
Background:
With the increasing use of left ventricular assist devices (LVADs) for longer-term support of patients awaiting cardiac transplantation, we must now consider whether to use these devices as alternatives to medical therapy when biologic hearts are needed but not forthcoming. This expansion of use depends as much on quality of life as it does on survival. To draw an inference about long-term quality of life with implanted LVADs, we studied "bridged" patients at our institution.
Methods:
We elicited, by standard gamble, the utilities (preferences) of bridged patients at three points in their care: before LVAD implantation, during LVAD support, and after cardiac transplantation.
Results:
Utility was 0.548 (+/-0.276) before implantation, 0.809 (+/-0.136) during LVAD support, and 0.964 (+/-0.089) after transplantation. For patients interviewed during all three states of health, the utilities were significantly different (p = 0.0009 by analysis of variance).
Conclusions:
The quality of life with an LVAD was substantially better than with medical therapy, on par with renal transplantation (as established by others), and not as good as after cardiac transplantation. These results portend an acceptable quality of life for long-term use of LVADs for patients with end-stage heart failure and contribute to the growing body of evidence supporting a clinical trial to test this new use.