Beyond survival: Recommendations from INTERMACS for assessing function and quality of life with mechanical circulatory support

摘要

Mechanical circulatory support (MCS) therapy has recently undergone more rapid evolution. Initially approved as a bridge to transplantation, MCS was employed primarily for short-term support to allow stabilization of organ function and subsequent transplantation. The advent of smaller continuous-flow pumps, with associated improvements in durability and clinical outcomes, has allowed destination therapy to become a sustainable treatment for advanced heart failure patients ineligible for transplantation. Faced with a horizon of support measured in years rather than months, health-related quality of life (HRQOL) and functional capacity have subsequently become increasingly relevant outcomes. Functional capacity (also referred to as exercise capacity) relates to the ability to perform meaningful physical activity. HRQOL is "the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient." Establishing recommendations for assessing HRQOL and functional capacity while on MCS is crucial to more clearly define the benefits of MCS, portray reasonable expectations for patients considering MCS implant, guide development of strategies aimed at enhancing these outcomes, and inform health policy decisions for rational allocation of this costly health resource.