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American Journal of Critical Care. 2002;11: 345-352
Copyright © 2002 by the American Association of Critical-Care Nurses.
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Predictors of Quality of Life at 1 Month After Implantation of a Left Ventricular Assist Device

By Kathleen L. Grady, RN, PhD, Peter Meyer, PhD, Annette Mattea, RN, MSN, Diane Dressler, RN, MSN, Sophia Ormaza, RN, MSN, Connie White-Williams, RN, MSN, Suzanne Chillcott, RN, BSN, Annemarie Kaan, RN, CTNC, Barbara Todd, RN, MSN, Alice Loo, RN, MSN, Annette L. Klemme, RN, BSN, William Piccione, MD and Maria Rosa Costanzo, MD. From Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Ill (KLG, PM, AM, WP, MRC), St. Luke’s Medical Center, Milwaukee, Wis (DD), University of Minnesota, Minneapolis, Minn (SO), University of Alabama, Birmingham, Ala (CW-W), Sharp Memorial Hospital, San Diego, Calif (SC), St. Vincent’s Hospital, Darlinghurst, Australia (AK), Temple University, Philadelphia, Pa (BT), University of Pennsylvania, Philadelphia, Pa (AL), and Fairfax Hospital, Falls Church, Va (ALK).


   Abstract
Top
 Abstract
Methods
 Results
 Discussion
 References
 
• Objectives To describe quality-of-life outcomes; determine relationships between quality of life and demographic, physical, psychosocial, and clinical variables; and identify predictors of quality of life at 1 month after implantation of a left ventricular assist device.

• Methods Patients who received either an implantable pneumatic (n = 38) or a vented electric (n = 54) left ventricular assist device as a bridge to heart transplantation between August 1, 1994, and August 31, 1999, completed 6 instruments used to measure quality of life and factors related to quality of life. Data were analyzed by using descriptive statistics, Pearson correlations, Mann-Whitney U tests, and forward, stepwise multiple regression.

• Results Overall satisfaction with quality of life was quite high as determined from the total score on the Quality of Life Index (mean = 0.69). Patients were very satisfied with the implantation and thought that they would do well after future heart transplant surgery. Patients had a moderate level of stress. Significant predictors of overall quality of life were psychological symptoms, stress, and race; these accounted for 46% of variance in quality of life.

• Conclusions Patients were satisfied with their quality of life at 1 month after implantation of a left ventricular assist device. However, they were least satisfied with their health and functioning and yet were optimistic about how well they thought they would do after heart transplantation. Psychological factors were the strongest predictors of satisfaction with overall quality of life.

Heart failure affects approximately 4.6 million persons in the United States; approximately 550 000 new cases are reported annually.1 Severe heart failure unresponsive to maximal medical therapy occurs in approximately 60 000 patients each year.2 Two-year survival in patients with New York Heart Association (NYHA) class IV heart failure is very poor (20%-30%).3 Heart transplantation has been a successful treatment for end-stage heart failure; the 1-year survival rate is 81%, and this rate decreases 4% per year through 15 years after transplantation.4

However, in the United States during the past decade, the median waiting time for adults listed as candidates for heart transplantation ranged from 42 to 397 days, depending on the patients’ United Network for Organ Sharing medical urgency status and blood type.5 From 1988 to 1998, only 3000 to 4500 heart transplantations were performed annually worldwide,4 and 500 to 1000 patients in the United States died each year while awaiting heart transplantation.5 Left ventricular assist devices (LVADs) have been developed in response to the disparity between the number of patients listed for heart transplantation and actual surgeries performed.6 The successful use of these devices prompted our examination of the quality of life of patients who have them implanted.

Examination of quality of life in patients with LVADs has been limited.7–12 Analyses have been descriptive, comparative, and qualitative (in a phenomenological approach), and sample sizes have been small (≤12 patients). We previously reported on quality of life in patients (n = 81) at 1 to 2 weeks after LVAD implantation and on improvement in quality of life in a subset of these patients (n = 30) from before to 1 to 2 weeks after LVAD implantation.13

Multivariate analyses have not been used to study quality of life in patients with LVADs. Understanding the relationships between quality of life and other variables will assist clinicians in determining factors that affect quality of life after implantation of these devices and in developing strategies to help patients improve quality of life.

This report is based on data from our prospective, longitudinal, multisite study of quality-of-life outcomes before and after LVAD implantation and after heart transplantation. In this article, we describe the quality of life in patients at 1 month after LVAD implantation; the relationships between quality of life and demographic, physical, psychosocial, and clinical variables; and predictors of quality of life. Quality of life was defined as "the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient."14 The following domains of quality of life were measured: physical and occupational function, psychological state, social interaction, and somatic sensation.14


   Methods
Top
 Abstract
 Methods
Results
 Discussion
 References
 
Sample
Patients who participated in this study received either an implantable pneumatic (n = 38) or a vented electric (n = 54) HeartMate LVAD (Thoratec Corp, Pleasanton, Calif) as a bridge to heart transplantation between August 1, 1994 and August 31, 1999, at 1 of 10 medical centers (9 in the United States and 1 in Australia). Both types of LVADs assist the failing left ventricle by pumping blood, via the aorta, throughout the body, with a maximum stroke volume of 83 mL and a pump output of 10 L/min.15,16 End-organ recovery and physical functional rehabilitation have been described by other researchers.17,18 Adult patients were eligible to enroll in the study if they were physically able to participate and could read and write English.

The nonrandom sample of patients (n = 150) was drawn from a pool of 281 patients. The 131 patients who did not participate in our study included 41 (31%) who had an LVAD implanted but died, 36 (27%) who were too ill to participate, 30 (23%) who refused to participate, 10 (8%) who received transplants before enrollment, 6 (5%) who were not enrolled by research staff, 5 (4%) who could not read or write English, and 3 (2%) who were illiterate.

At 1 month after LVAD implantation, 92 of the 150 patients enrolled in our study were able to complete booklets of quality-of-life questionnaires. The 58 patients who did not complete questionnaires at this time were too sick (45%), received a transplant sooner than 1 month after LVAD implantation (17%), had not yet joined the study (12%), did not complete the booklet (10%), or for other reasons did not return the questionnaires (17%).

Instruments
Completed booklets of instruments used to measure quality of life and factors related to quality of life are described in Table 1Go. The instruments were the Quality of Life Index,19 Rating Question Form,20 Heart Failure Symptom Checklist,21 Sickness Impact Profile,22 LVAD Stressor Scale,13 and Jalowiec Coping Scale.23 The order of the self-report instruments in the booklets differed from that used to assess quality of life in these patients at other times before or after LVAD implantation in order to control for the effects of fatigue, sensitization, and response bias. Clinical data, including cardiac history, hospitalizations, operative data, diagnostic data, complications, and medications, were collected from hospital and office records by coinvestigators each time a booklet was completed by a patient.


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  		Table 1 Self-report instruments used to measure quality of life and factors related to quality of life

 
Previous reports of reliability and validity of these instruments provide support for the use of these tools in our current analyses: Quality of Life Index,19,24 Rating Question Form,20 Heart Failure Symptom Checklist,21,25 Sickness Impact Profile,26,27 LVAD Stressor Scale,13 and Jalowiec Coping Scale.23 Also, internal consistency reliability was supported for all of the tools (except for the Rating Question Form, for which this type of reliability would not be expected because of the diversity of questions), as described in our report of improvement in quality of life 2 weeks after LVAD implantation.13

Procedures
This study was approved by the institutional review boards for the protection of human subjects at the 10 medical centers. Optimally, patients were enrolled in the study 1 to 4 days before implantation of the LVAD. Patients who were unable to participate at this time (the majority of whom were too ill) were enrolled as soon as possible after LVAD implantation. After the study was explained to the patients, they signed a consent form and were given a booklet of quality-of-life questionnaires to complete with instructions to return the booklet as soon as possible. At 1 month after LVAD implantation, patients were instructed to return the booklet to the site coordinator if they were hospitalized, or they were provided with a stamped, addressed envelope and told to mail the booklet if they were discharged. Clinical data, as previously described, were obtained from hospital and outpatient records by the coinvestigators at 1 month after LVAD implantation.

Design and Statistical Analyses
The study design was correlational. The data were analyzed by using SAS 6.12 (SAS, Cary, NC), S-Plus 2000 (S-Plus, Seattle, Wash), and SPSS 10.0 (SPSS, Inc, Chicago, Ill). Descriptive statistics, including frequencies and measures of central tendency ± SD, Pearson correlations, Mann-Whitney U tests, and forward, stepwise multiple regression were used. Forward, stepwise multiple regression was selected for the multivariate analysis to reduce problems that could arise from multicollinearity. Raw data were analyzed after mean total, subscale, and item scores were calculated for each instrument. Scores were converted to proportional scores by dividing the patients’ total, subscale, and/or item scores by the maximum possible score, a process that converted the scores to a standardized scale with a range of 0.00 to 1.00.

Before the regression analysis was done, relationships between independent variables (demographic, physical, psychosocial, and clinical variables) and the dependent variable (satisfaction with overall quality of life at 1 month after LVAD implantation, which was derived from the total score of the Quality of Life Index) were examined to detect significant associations. Independent variables significantly associated with overall quality of life at 1 month after LVAD implantation were considered candidate predictors and were entered into the forward, stepwise multiple regression analysis. The model fit was tested and was found to be good. Individual cases were examined to determine potential influential outliers, and because no case altered the coefficients by more than 1 SE, all cases were retained in the analysis. The level of significance used for our analysis was P ≤.05.


   Results
Top
 Abstract
 Methods
 Results
Discussion
 References
 
Descriptive Analyses
  Demographic and Clinical Characteristics.   The nonrandom sample of patients was middle-aged (mean, 51.5 years; SD, 11.7; range, 20–67), mostly male (92%), primarily white (79%), predominantly married (72%), and fairly well educated (mean, 13.5 years of education; SD, 2.9 years), as shown in Table 2Go. Diagnoses of patients who required an LVAD were ischemic cardiomyopathy (49%), dilated cardiomyopathy (46%), valvular heart disease (3%), and other (2%). These patients had had symptomatic heart failure for a mean of 6.2 years (SD, 6.6 years). Before LVAD implantation, patients were hospitalized for a mean of 19.5 days (SD, 21.2 days). Patients in the United States (n = 84) were listed with United Network for Organ Sharing to await heart transplantation as status 1 (92%), status 2 (1%), on hold (5%), or not applicable (2%). All patients in Australia (n = 8) were listed for heart transplantation. NYHA functional classification immediately before LVAD implantation indicated the extent of limitation in patients’ activities due to the signs and symptoms of heart failure: NYHA IV (94% of patients), NYHA III (4%), and NYHA II (2%). Left ventricular ejection fraction before LVAD implantation was severely impaired (mean, 0.21; SD, 0.08; normal, 0.45–0.65) in 71 patients for whom data were available.


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  		Table 2 Demographic characteristics of the sample 1 month after implantation of a left ventricular assist device (n = 92)

 
At 30 days after surgery, patients were doing well clinically. More than three fourths of the patients (77%) left the operating room in good, stable, or satisfactory condition; a few left the operating room in fair (16%) or guarded (7%) condition. Some patients required reoperation (20%). Mechanical complications with the LVAD occurred in a minority of patients (22%). Infections were common (74%). Most patients were still hospitalized (87%) 1 month after implantation; some patients were discharged to facilities near the hospital or to home (13%). All patients with an implantable pneumatic LVAD (n = 38; 2 of the 38 were using portable pneumatic drivers) awaited heart transplantation in the hospital because the pneumatic consoles and portable drivers were not approved by the US Food and Drug Administration for use at home.

  Quality-of-Life Variables.   Overall satisfaction with quality of life was quite high at 1 month after LVAD implantation, as determined from the total score (0.00 = very dissatisfied to 1.00 = very satisfied) on the Quality of Life Index (mean, 0.69; SD, 0.14). Satisfaction with quality of life by subscale from the Quality of Life Index was as follows: significant others (mean score, 0.82; SD, 0.13), socioeconomic (mean score, 0.73; SD, 0.17), psychological (mean score, 0.66; SD, 0.20), and health and functioning (mean score, 0.60; SD, 0.18). Specific items from the Quality of Life Index with which patients were most and least satisfied are listed in Table 3Go. Scores for areas of greatest satisfaction ranged from very satisfied to moderately satisfied (0.79–0.94), and scores for areas of least satisfaction ranged from slightly dissatisfied to slightly satisfied (0.42–0.60).


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  		Table 3 Areas of life with which patients were most and least satisfied*

 
Global ratings of quality of life reported by patients were more positive than negative (Table 4Go). The most positive global ratings were satisfaction with LVAD surgery and outcome after future heart transplant surgery. The least positive global ratings were for quality of life and stress level. When patients were asked if they still would have decided to have an LVAD implant knowing what they knew 1 month after implantation, 87% stated yes (76% definitely yes and 11% probably yes), 8% stated not sure, and 4% stated no (1% probably no and 3% definitely no). Patients who were positive about the experience stated the following reasons for having LVAD surgery: LVAD saved my life (51%), there was no alternative (19%), I feel better (14%), and I am stronger for the heart transplant (2%). Patients who were unsure or more negative about having LVAD surgery stated that they had a difficult postoperative course (2%), had a lot of pain (2%), did not want a machine (1%), experienced loss of freedom (1%), or were depressed (1%) or gave other reasons (7%).


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  		Table 4 Global ratings of areas of quality of life*

 
Multivariate Analysis
Significant multivariate predictors of overall quality of life at 1 month after LVAD implantation were psychological symptoms, race, and psychological stress; together these predictors accounted for 46% of variance in quality of life. Thus, LVAD patients who were more satisfied with their overall quality of life at 1 month after surgery were less bothered by psychological symptoms, were black, and had less psychological stress. The order of entry and unique contribution of each variable are listed in Table 5Go.


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  		Table 5 Predictors of better overall quality of life at 1 month after implantation of a left ventricular assist device

 

   Discussion
Top
 Abstract
 Methods
 Results
 Discussion
References
 
This article is the first report of data from a multivariate analysis of quality of life in patients with LVADs who are awaiting heart transplantation. The results indicate that almost half of the variability in satisfaction with overall quality of life at 1 month after LVAD implantation was explained by psychological factors and a single demographic factor (race).

It is not surprising that psychological factors were highly related to quality of life. Psychological symptoms from the Heart Failure Symptom Checklist that patients can report being bothered by include irritability, feeling sad, feeling lack of control over one’s life, feeling anxious or apprehensive, and feeling depressed. Stressors from the LVAD Stressor Scale include worrying that the LVAD might not work well, worrying about complications (getting an infection), waiting for a donor heart to be found, and being away from family. Better quality of life was explained by being less bothered by psychological symptoms and having less psychological stress.

The strong relationship between quality of life and psychological factors was also reported by Dew et al.28 In their study of patients’ perceptions after implantation of a ventricular assist device, patients described worry and concerns about device noise, device malfunction, and possible infection. In addition, in our earlier studies of quality of life in patients both before29 and after30 heart transplantation, we detected significant multivariate relationships between quality of life and psychological state. Molzahn et al31 also reported that a psychological factor, outlook, was a predictor of quality of life in both heart transplant candidates and heart transplant recipients. These findings support the need to assess LVAD patients’ psychological state and provide interventions as needed, including (1) education about the LVAD to reduce stress and (2) psychological and psychiatric consultation.

The relationship between quality of life and race was surprising. Being black was associated with better quality of life at 1 month after LVAD implantation. The reasons for this relationship are unclear. African Americans may simply have a more positive outlook on life, or other factors may distinguish them in some way from other races. The effects of other factors, such as spirituality and religiosity, were not thoroughly examined in our study. Cooper-Patrick et al32 reported that black patients made more comments than did white patients about the impact of spirituality in seeking treatment. Church members were also cited more frequently by black patients as sources of support than by white patients in this study.32 Further study of this relationship is warranted.

Patients overwhelmingly indicated that they were satisfied with the outcome of their LVAD surgery and expected to do well after heart transplantation. The majority of patients thought that the LVAD saved their lives, and most patients stated that they would agree to LVAD implantation again knowing what they knew 1 month after the surgery. Dew et al28 also reported that most patients would consent again to receiving a ventricular assist device and would recommend implantation of such a device to others. In our study, this positive response was attenuated by less positive ratings for stress and quality of life, which were probably tempered by the reality of having survived surgery and yet requiring an LVAD. In addition, the rating for health/functioning, although positive, was still the area of least satisfaction when all 4 subscales of the Quality of Life Index were examined. Therefore, support of patients psychologically, physically, socially, and educationally is paramount to early enhancement of quality of life.

Limitations of this study include the assessment of quality of life in only 92 of the 150 patients enrolled in the overall study. Because almost half of the patients who did not answer the booklet of instruments were too sick to complete the questionnaires, we may have overestimated quality of life at 1 month after LVAD implantation. In addition, only 150 of the pool of 281 patients were enrolled in our study, approximately one third of the patients who were not enrolled died, and a little less than one third of patients not enrolled were too sick to be enrolled. Thus, it is important to emphasize that we assessed quality of life in survivors of LVAD implantation who were well enough to be enrolled in our study. Last, although the time (1 month after LVAD implantation) selected for our multivariate analyses is relatively short, we selected that time because an understanding of predictors of quality of life early after device implantation, when most patients who receive the devices are still hospitalized, may contribute to the development of interventions for patients at risk for poor quality of life before the patients are discharged. Furthermore, no correlational data on quality of life at any time after LVAD implantation are available.

In conclusion, at 1 month after LVAD implantation, patients were satisfied with their quality of life, and the majority of patients stated that the LVAD saved their lives. However, patients were least satisfied with their health and functioning, and yet were very optimistic about how well they thought they would do after future heart transplant surgery. Psychological factors were most strongly predictive of satisfaction with overall quality of life. Psychological assessment and intervention for all LVAD patients are highly recommended both before implantation and within 1 month after surgery. Determining the psychological factors that affect quality of life and developing interventions to address these factors may improve quality of life in patients with LVADs who are awaiting heart transplantation. Because LVADs have been studied as permanently implantable devices, the study of outcomes, especially quality of life, in patients with LVADs is very important.


   ACKNOWLEDGMENTS
 
This work was supported by a grant-in-aid from the American Heart Association and intramural funding from the Rush Heart Institute, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Ill.

To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.


   REFERENCES
Top
 Abstract
 Methods
 Results
 Discussion
 References
 

  1. American Heart Association. 2000 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association, 1999.
  2. Funk D. Epidemiology of end-stage heart disease. In: Hogness JR, Van Antwerp M, eds. The Artificial Heart: Prototypes, Policies, and Patients/Committee to Evaluate the Artificial Heart Program of the National Heart, Lung, and Blood Institute. Washington, DC: National Academy Press; 1991:251–261.
  3. Schocken DD, Arrieta MI, Leaverton PE, Ross EA. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol. 1992;20:301–306.[Abstract]
  4. Hosenpud JD, Bennett LE, Keck BM, Boucek MM, Novick RJ. The Registry of the International Society for Heart and Lung Transplantation: eighteenth official report—2001. J Heart Lung Transplant. 2001;20:805–815.[Medline]
  5. Kauffman HM, McBride MA, Shield CF, Daily OP, Wolf JS, Kirklin JK. Determinants of waiting time for heart transplants in the United States. J Heart Lung Transplant. 1999;18:414–419.[Medline]
  6. Oz MC, Argenziano M, Catanese KA, et al. Bridge experience with long-term implantable left ventricular assist devices. Circulation. 1997;95:1844–1852.[Abstract/Free Full Text]
  7. Moskowitz AJ, Weinberg AD, Oz MC, Williams DL. Quality of life with an implanted left ventricular assist device. Ann Thorac Surg. 1997;64:1764–1769.[Abstract/Free Full Text]
  8. Dew MA, Kormos RL, Winowich S, et al. Quality of life outcomes in left ventricular assist system inpatients and outpatients. ASAIO J. 1999;45:218–225.[Medline]
  9. Catanese KA, Goldstein DJ, Williams DL, et al. Outpatient left ventricular assist device support: a destination rather than a bridge. Ann Thorac Surg. 1996;62:646–653.[Abstract/Free Full Text]
  10. Ruzevich SA, Swartz MT, Reedy JE, et al. Retrospective analysis of the psychological effects of mechanical circulatory support. J Heart Transplant. 1990;9:209–212.[Medline]
  11. Abou-Awdi NL, Frazier OH. Quality of life of patients on LVAD support. In: Quality of Life After Heart Surgery. New York, NY: Kluwer Academic Publishers; 1992:397–401.
  12. Savage LS, Conody C. Life with a left ventricular assist device: the patient’s perspective. Am J Crit Care. 1999;8:340–343.[Abstract]
  13. Grady KL, Meyer P, Mattea A, et al. Improvement in quality of life outcomes two weeks after left ventricular assist device implantation. J Heart Lung Transplant. 2001;20:657–669.[Medline]
  14. Spilker B, ed. Quality of Life Assessments in Clinical Trials. New York, NY: Raven Press; 1990.
  15. Frazier OH, Duncan JM, Radovancevic B, et al. Successful bridge to heart transplantation with a new left ventricular assist device. J Heart Lung Transplant. 1992;11:530–537.[Medline]
  16. Frazier OH. First use of an untethered, vented electric left ventricular assist device for long-term support. Circulation. 1994;89:2908–2914.[Abstract/Free Full Text]
  17. McCarthy PM, Savage RM, Fraser CD, et al. Hemodynamic and physiologic changes during support with an implantable left ventricular assist device. J Thorac Cardiovasc Surg. 1995;109:409–417.[Abstract/Free Full Text]
  18. Frazier OH, Rose EA, McCarthy P, et al. Improved morality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system. Ann Surg. 1995;222:327–338.[Medline]
  19. Ferrans CE, Powers MJ. Quality of Life Index: development and psychometric properties. Adv Nurs Sci. 1985;8:15–24.[Medline]
  20. Grady KL, Jalowiec A, White-Williams C. Patient compliance at one year and two years after heart transplantation. J Heart Lung Transplant. 1998;17:383–394.[Medline]
  21. Grady KL, Jalowiec A, Grusk BB, White-Williams C, Robinson JA. Symptom distress in cardiac transplant candidates. Heart Lung. 1992;21:434–439.[Medline]
  22. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981;19:787–806.[Medline]
  23. Jalowiec A. Update on the Jalowiec Coping Scale. In: Strickland OL, Dilorio C, eds. Measurement of Nursing Outcomes. Vol. 1. 2nd ed. New York, NY: Springer Publishing Co. In press.
  24. Ferrans CE, Powers MJ. Psychometric assessment of the Quality of Life Index. Res Nurs Health. 1985;15:29–38.
  25. Jalowiec A, Grady KL, White-Williams C, et al. Symptom distress 3 months after transplant. J Heart Lung Transplant. 1997;16:604–614.[Medline]
  26. Bergner M, Bobbitt RA, Pollard WE, Martin OP, Gilson BS. The Sickness Impact Profile: validation of a health status measure. Med Care. 1976;14:57–67.[Medline]
  27. Pollard WE, Bobbitt RA, Bergner MB, Martin DP, Gibson GP. The Sickness Impact Profile: reliability of a health status measure. Med Care. 1976;14:146–155.[Medline]
  28. Dew MA, Kormos RL, Winowich S, et al. Human factors issues in ventricular assist device recipients and their family caregivers. ASAIO J. 2000;46:367–373.[Medline]
  29. Grady KL, Jalowiec A, White-Williams C, et al. Predictors of quality of life in patients with advanced heart failure awaiting transplantation. J Heart Lung Transplant. 1995;14:2–10.[Medline]
  30. Grady KL, Jalowiec A, White-Williams C. Predictors of quality of life in patients at one year after heart transplantation. J Heart Lung Transplant. 1999;18:202–210.[Medline]
  31. Molzahn AE, Burton JR, McCormick P, Modry DL, Soetaert P, Taylor P. Quality of life of candidates for and recipients of heart transplant. Can J Cardiol. 1997;13:141–146.[Medline]
  32. Cooper-Patrick L, Powe NR, Jenckes MW, Gonzales JJ, Levine DM, Ford DE. Identification of patient attitudes and preferences regarding treatment of depression. J Gen Intern Med. 1997;12:431–438.[Medline]



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