Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation.

The severity of heart failure has traditionally been characterized using the New York Heart Association (NYHA) functional classification system and gauges the severity of symptoms for patients who have American Heart Association Stage C or D heart failure.1 Patients with advanced heart failure with NYHA Class III or IV symptoms have limitations in daily activities despite optimal medical management. However, not all patients with advanced heart failure have a similar prognosis. Investigators of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS, a prospective registry that collects data on all patients who receive a durable, FDA approved mechanical circulatory support [MCS] device in the United States) developed a classification system of patient profiles to further characterize the severity of heart failure in this high risk population of patients undergoing treatment with MCS.2 Seven patient profiles (1=critical cardiogenic shock to 7=advanced NYHA Class III symptoms) were defined based on clinical descriptors at the time of MCS implant.2, 3 INTERMACS profiles have been used to characterize risk for poor outcomes after MCS implantation. Stepanenko et al.,4 in their study on outcomes of elective versus emergent permanent (i.e., destination therapy) MCS in elderly patients with advanced heart failure, reported that patients not requiring inotrope support (INTERMACS profiles 4–7) had lower operative mortality than patients with cardiogenic shock on high dose inotropes (INTERMACS profiles 1–3), cautiously concluding that permanent MCS may benefit highly selected elderly patients. In another study, patients with INTERMACS profiles 4–7 had better actuarial survival and a shorter hospital length of stay than patients with INTERMACS profile 1.5 Kirklin et al.6 reported that INTERMACS profile 1 is a risk factor for death early after MCS implantation as destination therapy. Regarding patient-reported health related quality of life (HRQOL) outcomes, researchers have demonstrated improved HRQOL through as long as 2 years after MCS implantation for both bridge to transplant and destination therapy.7–10 However, improvement in HRQOL from before to after MCS implantation across the spectrum of heart failure severity is unknown. Given that pre-implant heart failure severity affects post implant clinical outcomes, it may affect post implant HRQOL outcomes as well. Determining MCS HRQOL benefits and risks, stratified by heart failure severity, may provide important information with which to inform patients who are considering MCS implantation, and thereby help patients make more informed health care decisions, given that severely ill patients make decisions on treatment options (e.g., including surgical therapies or continued medical therapy / palliative care / hospice), based on outcomes, including HRQOL, as well as survival.11–14 Such information may also guide development of more targeted strategies to enhance HRQOL after implant. Understanding HRQOL benefits of MCS is especially important for patients who receive MCS as destination therapy. In the future, indications for destination therapy MCS may expand to include patients with moderately advanced heart failure, thus providing further impetus for understanding variation in post MCS HRQOL outcomes by pre-implant advanced heart failure severity.15 The purpose of our study was to examine differences in HRQOL outcomes from before MCS implantation through 1 year after surgery among patients receiving continuous flow pumps, stratified by INTERMACS patient profiles. We defined HRQOL as “the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient.”16