282: Quality of life two or more years following LVAD removal

Purpose: Recent advances have led to an increasing number of treatment options for patients with advanced heart failure. Many of these options increase life expectancy with a varying effect on quality of life. In order to provide care that reflects patients’ wishes, we must first identify what their preferences are. This study determined the treatment preferences of patients with heart failure (HF) stratified by NYHA Class II and IV symptoms for three distinct treatment options: optimal medical management (OMM), oral inotropes or LVAD support. Methods and Materials: We enrolled 92 patients (NYHA II 49, NYHA IV 43). Each patient completed a treatment tradeoff instrument, Minnesota Living with HF Questionnaire (MLHFQ) and visual analog scales (VAS) for perceived severity of overall heath, dyspnea and fatigue. Results: Compared to class II patients, those with class IV symptoms had significantly worse MLHFQ scores, dyspnea, fatigue and overall health (p 0.05). In rank order, the most preferred treatment options were inotropes, LVAD and OMM. There were no differences in treatment preferences between NYHA II and NYHA IV patients. Patients in the worst terciles of MLHFQ and VAS scores did not significantly differ in their treatment preferences versus those in the lower terciles. By multivariate analysis, MLHFQ, VAS and NYHA Class did not influence treatment choices. However, older patients (age 60years) were less likely to prefer aggressive treatment with LVAD therapy compared to younger patients. Conclusions: The results of this study suggest patients with heart failure prefer treatment options that improve quality of life. There does not appear to be an effect of functional or symptom status on treatment preference and the finding of no difference between groups suggests treatment preferences may be decided early in the course of illness. Although the results of this study cannot be assumed to predict individual preferences they may serve as an impetus for clinicians to discuss end-of-life treatment preferences with patients early in their course of illness.