Neurocognitive status and QOL following the Novel HeartWare® Left Ventricular Assist Device (LVAD)
Birks, E., Streuber, M., O'Driscoll, G., Jansz, P., Meyer, A., Schima, H., et al. (2008). Neurocognitive status and QOL following the novel HeartWare® Left Ventricular Assist Device (LVAD). Journal of Cardiac Failure, 14(6), S56. doi: 10.1016/j.cardfail.2008.06.175
Introduction: HeartWare® is a new centrifugal third generation LVAD. Its small size (allowing a less invasive implant procedure), good flows and user friendly software might influence quality of life (QOL). Hence we report initial health-related QOL and neurocognitive data from a multi-center prospective non-randomized study of the HeartWare® VAD.
Methods: Thirty patients were enrolled at 5 centres and preliminary results for a sample of 11 patients (age 46.5 (28–60) yrs) tested before implant (baseline), 4 weeks and 3 months post-implant are reported. Patients were included in the analysis if they had complete QOL and neurocognitive data for the 3 time-points. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to measure health-related functional status and QOL. The neurocognitive battery consisted of measures of verbal memory, cognitive speed, attention, language, planning, and mental flexibility.
Results: Actuarial survival (n = 30) was 93% at 180 days and 86% at 1 year. For the 11 patients with complete data, QOL improved on every subscale of the KCCQ. Individually, 55% (n = 6) reported clinically significant improvement in health-related functional status and QOL, 27% (n = 3) no change, and 18% (n = 2) a decline at 3 months post-surgery vs. baseline. Reduction in symptom burden was the most noticeable change in QOL with 45.5% (n = 5) reporting significant improvement and 54.5% (n = 16) reporting no change and no worsening in the impact of symptoms on their daily lives at 3 months post-surgery vs. baseline. Prior to LVAD implant, patients as a group were impaired on tests of verbal memory and mental flexibility compared to age-matched norms. Four weeks after surgery, neurocognitive status remained the same or improved for the majority. A subset of patients showed transient declines in verbal memory ability (n = 3), language (n = 1) and planning (n = 2) after 4 weeks that improved to baseline or near baseline levels by 3 months. Of note statistically significant improvements in verbal memory ability occured in 40% and in mental flexibility in 45.5% 3 months post-surgery vs.baseline.
Conclusions: QOL is substantially improved 3 months after HeartWare® implant in the majority of patients. Patients showed significant improvements or no change in neurocognitive status 3 months after LVAD, likely attributable to decreased symptom burden and improved overall functional status.