Patient-Reported Health-Related Quality of Life Is a Predictor of Outcomes in Ambulatory Heart Failure Patients Treated With Left Ventricular Assist Device Compared With Medical Management

Left ventricular assist devices (LVADs) are approved for use in patients in stage D heart failure (HF), either as bridge to transplantation or as permanent (destination) therapy. The optimal timing of LVAD implantation along the continuum of chronic HF is under active investigation. Most patients currently being implanted with LVADs have significant hemodynamic compromise, usually necessitating inotropic support or temporary mechanical support. However, severe hemodynamic derangement at the time of LVAD implantation has been associated with increased risk of mortality and morbidity compared with less-sick patients. Whether LVAD implantation at an earlier stage of chronic HF would lead to favorable outcomes as compared with continued optimal medical management (OMM) of HF was tested in the ROADMAP study (Risk Assessment and Comparative Effectiveness of LVAD and Medical Management). This was a prospective, Original Article