Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric

医学 植入 生活质量(医疗保健) 逻辑回归 心室辅助装置 公制(单位) 内科学 外科 心力衰竭 运营管理 护理部 经济
作者
Guangyu Yang,Min Zhang,Shiwei Zhou,Hechuan Hou,Kathleen L. Grady,J. Stewart,Carol Chenoweth,Keith D. Aaronson,Michael D. Fetters,P. Paul Chandanabhumma,Michael J. Pienta,Preeti Malani,Ahmad Hider,Lourdes Cabrera,Francis D. Pagani,Donald S. Likosky
出处
期刊:Journal of Heart and Lung Transplantation [Elsevier BV]
卷期号:41 (10): 1520-1528 被引量:3
标识
DOI:10.1016/j.healun.2022.07.001
摘要

Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons' Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric.Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire "KCCQ") incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant.The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04).Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.
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