A comparison of quality-adjusted life years in older adults after heart transplantation versus long-term mechanical support: Findings from the SUSTAIN-IT study.

Autor:	Grady KL; Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois. Electronic address: kgrady@nm.org., Dew MA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania., Pagani FD; Cardiac Surgery, University of Michigan, Ann Arbor, Michigan., Spertus JA; Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri., Hsich E; Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Yuzefpolskaya M; Department of Medicine, Division of Cardiology, Columbia University, New York, New York., Lampert B; Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio., Kirklin JK; Kirklin Solutions, Hoover, Alabama., Petty M; Department of Nursing, University of Minnesota Medical Center, Fairview, Minnesota., Kao A; Cardiovascular Disease, Advanced Heart Failure and Transplant Cardiology, St. Luke's Health System, Kansas City, Missouri., Yancy C; Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois., Hartupee J; Department of Medicine, Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri., Pamboukian SV; Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington., Johnson M; Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin., Murray M; Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin., Wu T; Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois., Andrei AC; Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2024 Sep; Vol. 43 (9), pp. 1422-1433. Date of Electronic Publication: 2024 May 17.
DOI:	10.1016/j.healun.2024.05.008
Abstrakt:	Background: The quality-adjusted life year (QALY) measures disease burden and treatment, combining overall survival and health-related quality of life (HRQOL). We estimated QALYs in 3 groups of older patients (60-80 years) with heart failure (HF) who underwent heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or HT without pre-transplant MCS [HT Non-MCS]) or long-term MCS (destination therapy). We also identified factors associated with gains in QALYs through 24 months follow-up. Methods: Of 393 eligible patients enrolled (10/1/15-12/31/18) at 13 U.S. sites, 161 underwent HT (n = 68 HT MCS, n = 93 HT Non-MCS) and 144 underwent long-term MCS. Survival and HRQOL data were collected through 24 months. QALY health utilities were based on patient self-report of EQ-5D-3L dimensions. Mean-restricted QALYs were compared among groups using generalized linear models. Results: For the entire cohort, mean age in years closest to surgery was 67 (standard deviation, SD: 4.7), 78% were male, and 83% were White. By 18 months post-surgery, sustained significant differences in adjusted average ± SD QALYs emerged across groups, with the HT Non-MCS group having the highest average QALYs (24-month window: HT Non-MCS = 22.58 ± 1.1, HT MCS = 19.53 ± 1.33, Long-term MCS = 19.49 ± 1.3, p = 0.003). At 24 months post-operatively, a lower gain in QALYs was associated with HT MCS, long-term MCS, a lower pre-operative LVEF, NYHA class III or IV before surgery, and an ischemic or other etiology of HF. Conclusions: Determination of QALYs may provide important information for policy makers and clinicians to consider regarding benefits of HT and long-term MCS as treatment options for older patients with HF. (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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