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Choi JJ, Bhasin S, Levstik J, Walsh P, Oldham MA, Lee HB. Association between psychosocial factors and left ventricular assist device implant outcomes: A systematic review. Gen Hosp Psychiatry 2024; 90:132-140. [PMID: 39180882 DOI: 10.1016/j.genhosppsych.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Psychosocial assessment is a core component of the multidisciplinary evaluation for left ventricular assist device (LVAD) implantation. The degree to which psychosocial conditions are considered a contraindication to LVAD implantation continues to be debated. This systematic review examines modifiable psychosocial factors as predictors of outcomes in patients undergoing LVAD implantation. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search resulted in 2509 articles. After deduplication, abstract and full-text review, 20 relevant articles were identified. RESULTS Included studies evaluated socioeconomic status (n = 6), caregiver characteristics (n = 6), non-adherence (n = 6), substance use (n = 13), and psychiatric disorder (n = 8). The most commonly measured outcomes were all-cause death, readmission rate, and adverse events. Studies varied widely in definition of each psychosocial factor and selected outcomes. No psychosocial factor was consistently associated with a specific outcome in all studies. Socioeconomic status was generally not associated with outcomes. Non-adherence, psychiatric disorder, and substance use were associated with higher risks of mortality, adverse events, and/or readmission. Findings on caregiver characteristics were mixed. CONCLUSION Of the psychosocial factors studied, non-adherence, psychiatric disorder, and substance use were the most consistently associated with an increased risk of mortality, readmission, and/or adverse events. Heterogeneity in research methodology and study quality across studies precludes firm conclusions regarding the impact of psychosocial factors on long-term patient outcomes. The results of this review reveal a need for adequately powered studies that use uniform definitions of psychosocial factors to clarify relationships between these factors and outcomes after LVAD implantation.
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Affiliation(s)
- Joy J Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Shreya Bhasin
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Johannes Levstik
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Hochang Benjamin Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Yu J, Petersen MR, Meece LE, Jeng EI, Al-Ani MA, Parker AM, Vilaro JR, Aranda JM, Ahmed MM. A new opportunity for patient selection and optimization: Systematic review of cognitive frailty in patients undergoing left ventricular assist device implantation. Geriatr Gerontol Int 2024; 24:204-210. [PMID: 38199969 DOI: 10.1111/ggi.14798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
The prognostic implication of cognitive frailty assessment in patients undergoing left ventricular assist device (LVAD) implantation remains unclear. We conducted a systematic review to evaluate assessment strategies and their significance for patients undergoing LVAD implantation. A comprehensive search of PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature from inception until September 2022 and a review of meeting proceedings were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that investigated the prognostic value of cognitive frailty or any related cognition-based assessment in patients undergoing LVAD implantation were included. Study characteristics, patient demographics, and type of cognitive assessment were extracted. Primary outcomes included length of stay, readmissions, and all-cause mortality. Of 664 records retrieved, 12 (4 prospective, 8 retrospective) involving 16 737 subjects (mean age, 56.9 years; 78.3% men) met inclusion criteria; 67% of studies used the Montreal Cognitive Assessment to assess cognitive frailty. Outcomes reported were highly variable, with 42% reporting readmission, 33% reporting LOS, and 83% reporting mortality data; only two studies provided data on all three. Cognitive frailty was associated with prolonged length of stay in 75% of studies reporting this outcome. Only 40% and 60% of studies that reported readmissions and mortality outcomes, respectively, suggested a predictive association. Pre-LVAD cognitive frailty is likely associated with worse outcomes postimplant. However, the heterogenous reporting of outcomes data and lack of consistent definitions in the literature limit its prognostic value. Additional research on markers for cognitive frailty and improved standards of reporting may allow for future analyses and enhance preoperative risk assessment and patient care. Geriatr Gerontol Int 2024; 24: 204-210.
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Affiliation(s)
- Julia Yu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matthew R Petersen
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Lauren E Meece
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Eric I Jeng
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Mohammad A Al-Ani
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Alex M Parker
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Juan R Vilaro
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Juan M Aranda
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
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Xu S, Gu YF, Dong AH. Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms. World J Psychiatry 2023; 13:1046-1052. [PMID: 38186725 PMCID: PMC10768496 DOI: 10.5498/wjp.v13.i12.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The emergency department plays a crucial role in providing acute care to patients. Nursing interventions in this setting are essential for improving the continuity of care, enhancing patients' self-care abilities, and reducing psychological symp-toms. AIM To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency department. METHODS A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May 2023. The patients were divided into two groups: The control group (conventional nursing intervention) and the observation group (conventional nursing intervention + emergency department nursing intervention). The two groups were compared regarding continuity of care, self-care ability, psychological symptoms, and satisfaction with care. RESULTS The emergency department nursing interventions significantly improved the continuity of care, enhanced patients' self-care abilities, and reduced psychological symptoms such as anxiety and depression. CONCLUSION Nursing interventions in the emergency department positively impact continuity of care, self-care, and psychological symptoms. However, it is important to acknowledge the limitations of this study, including the small number of studies, variable methodological quality, and the heterogeneity of the study population. Future research should address these limitations and further explore the effects of different types of nursing interventions in the emergency department. Additionally, efforts should be made to enhance the application and evaluation of these interventions in clinical practice.
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Affiliation(s)
- Song Xu
- Department of Emergency Room, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Yi-Fang Gu
- Department of Emergency Room, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Ai-Hua Dong
- Department of Emergency Room, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Thomas M, Spertus JA, Andrei AC, Wu T, Farr SL, Warzecha A, Grady KL. Association Between Caregiver Burden and Patient Recovery After Left Ventricular Assist Device Implantation: Insights From Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support. J Cardiovasc Nurs 2023; 38:237-246. [PMID: 37027128 PMCID: PMC10885691 DOI: 10.1097/jcn.0000000000000972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
INTRODUCTION After left ventricular assist device (LVAD) implantation, caregivers may experience increasing burden because of new roles and responsibilities. We examined the association between caregiver burden at baseline and patient recovery after long-term LVAD implantation in patients ineligible for heart transplantation. METHODS Between October 1, 2015, and December 31, 2018, data from 60 patients with a long-term LVAD (age, 60-80 years) and caregivers through 1 postoperative year were analyzed. Caregiver burden was measured using the Oberst Caregiving Burden Scale, a validated instrument used for measuring caregiver burden. Patient recovery post-LVAD implantation was defined by change in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) overall summary score and rehospitalizations over 1 year. Multivariable regression models (least-squares for change in KCCQ-12 and Fine-Gray cumulative incidence for rehospitalizations) were used to assess for association with caregiver burden. RESULTS Patients were 69.4 ± 5.5 years old, 85% men, and 90% White. Over the first year post-LVAD implantation, there was a 32% cumulative probability of rehospitalization; 72% (43/60) of patients had an improvement of ≥5 points in KCCQ-12 scores. Caregivers were 61.2 ± 11.5 years old, 93% women, 81% White, and 85% married. Median Oberst Caregiving Burden Scale Difficulty and Time scores at baseline were 1.13 and 2.27, respectively. Higher caregiver burden was not significantly associated with hospitalizations or change in patient health-related quality of life during the first year post-LVAD implantation. CONCLUSIONS Higher caregiver burden at baseline was not associated with patient recovery in the first year after LVAD implantation. Understanding the associations between caregiver burden and patient outcomes after LVAD implantation is important as excessive caregiver burden is a relative contraindication for LVAD implantation.
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Affiliation(s)
- Merrill Thomas
- University of Missouri-Kansas City School of Medicine
- Saint Luke’s Mid America Heart Institute
| | - John A. Spertus
- University of Missouri-Kansas City School of Medicine
- Saint Luke’s Mid America Heart Institute
| | | | - Tingqing Wu
- Feinberg School of Medicine, Northwestern University
| | - Stacy L. Farr
- University of Missouri-Kansas City School of Medicine
- Saint Luke’s Mid America Heart Institute
| | - Anna Warzecha
- Feinberg School of Medicine, Northwestern University
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Olt CK, Thuita LW, Soltesz EG, Tong MZ, Weiss AJ, Kendall K, Estep JD, Blackstone EH, Hsich EM. Value of psychosocial evaluation for left ventricular assist device candidates. J Thorac Cardiovasc Surg 2023; 165:1111-1121.e12. [PMID: 34053742 PMCID: PMC10443599 DOI: 10.1016/j.jtcvs.2021.04.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Left ventricular assist devices require a psychosocial assessment to determine candidacy despite limited data correlating with outcome. Our objective is to determine whether the Stanford Integrated Psychosocial Assessment for Transplant, a tool validated for transplant and widely used by left ventricular assist device programs, predicts left ventricular assist device program hospital readmissions and death. METHODS We performed a retrospective analysis of adults at the Cleveland Clinic with Stanford Integrated Psychosocial Assessment for Transplant scores before primary left ventricular assist device program implantation from April 1, 2013, to December 31, 2018. The primary outcome was unplanned hospital readmissions censored at death, transplantation, and transfer of care. The secondary outcome was death. RESULTS There were 263 patients in the left ventricular assist device program with a median (Q1, Q3) Stanford Integrated Psychosocial Assessment for Transplant score of 16 (8, 28). During a median follow-up 1.2 years, 56 died, 65 underwent transplantation, and 21 had transferred care. There were 640 unplanned hospital readmissions among 250 patients with at least 1 outpatient visit at our center. In a multivariable analysis, Stanford Integrated Psychosocial Assessment for Transplant components but not total Stanford Integrated Psychosocial Assessment for Transplant score was associated with readmissions. Psychopathology (Stanford Integrated Psychosocial Assessment for Transplant C-IX) was associated with hemocompatibility (coefficient 0.21 ± standard error 0.11, P = .040) and cardiac (0.15 ± 0.065, P = .02) readmissions. Patient readiness was associated with noncardiac (Stanford Integrated Psychosocial Assessment for Transplant A-III, 0.24 ± 0.099, P = .016) and cardiac (Stanford Integrated Psychosocial Assessment for Transplant A-low total, 0.037 ± 0.014, P = .007) readmissions. Poor living environment (Stanford Integrated Psychosocial Assessment for Transplant B-VIII) was associated with device-related readmissions (0.83 ± 0.34, P = .014). Death was associated with organic psychopathology or neurocognitive impairment (Stanford Integrated Psychosocial Assessment for Transplant C-X, 0.59 ± 0.21, P = .006). CONCLUSIONS Total Stanford Integrated Psychosocial Assessment for Transplant score was not associated with left ventricular assist device program readmission or mortality. However, we identified certain Stanford Integrated Psychosocial Assessment for Transplant components that were associated with outcome and could be used to create a left ventricular assist device program specific psychosocial tool.
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Affiliation(s)
| | - Lucy W Thuita
- Department of Quantitative Health Sciences, Cleveland, Ohio
| | - Edward G Soltesz
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael Z Tong
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aaron J Weiss
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | | | - Jerry D Estep
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Quantitative Health Sciences, Cleveland, Ohio; Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio; Transplant Center, Cleveland, Ohio
| | - Eileen M Hsich
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Kato NP, Melnikov S, Denfeld QE, Casida J, Strömberg A, Ben-Gal T, Lee CS, Jaarsma T. Validity and reliability of the left ventricular assist device self-care behaviour scale. PLoS One 2023; 18:e0275465. [PMID: 36763631 PMCID: PMC9917258 DOI: 10.1371/journal.pone.0275465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/18/2022] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Adequate self-care behaviour is essential for patients with a left ventricular assist device (LVAD) to prevent complications, prolong life, and optimise quality of life. However, there were no valid and reliable measurements available to assess self-care behaviour among patients with LVAD. We have previously developed the 33-item LVAD self-care behaviour scale. OBJECTIVES To evaluate psychometric properties of the 33-item LVAD self-care behaviour scale. METHODS AND RESULTS Data on 127 patients with a LVAD in Israel, Japan, and the USA were analysed (mean age 51±14.3, 81% male). Exploratory factor analysis extracted three factors, and 13 items were excluded from the scale. Internal consistency assessed by Cronbach's alpha was acceptable for the total scale (α = 0.80) and the three subscales: Factor 1: Monitoring (α = 0.81), Factor 2: Heart failure self-care (α = 0.67), and Factor 3: LVAD self-care (α = 0.63). The 20-item version of the LVAD self-care behaviour scale had sufficient convergent validity with another scale that assessed self-care related to the driveline of LVAD (r = 0.47, p<0.001). Test-retest reliability was adequate (intraclass correlation coefficient = 0.58). CONCLUSIONS The 20-item version of the LVAD self-care behaviour scale showed adequate validity and reliability. The scale is ready for use in clinical practice and research. Additional testing might further optimise the scale.
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Affiliation(s)
- Naoko P. Kato
- Department of Health, Division of Nursing Sciences and Reproductive Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan
- * E-mail:
| | - Semyon Melnikov
- Sackler Faculty of Medicine, Department of Nursing, Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Quin E. Denfeld
- School of Nursing & Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Jesus Casida
- Eleanor Mann School of Nursing, The University of Arkansas, Fayetteville, Arkansas, United States of America
| | - Anna Strömberg
- Department of Health, Division of Nursing Sciences and Reproductive Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tuvia Ben-Gal
- Sackler Faculty of Medicine, Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Christopher S. Lee
- The Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts, United States of America
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Tiny Jaarsma
- Department of Health, Division of Nursing Sciences and Reproductive Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Amstad T, Taeymans J, Englberger L, Mohacsi P, Steiner D, Wilhelm MJ, Hermann M. Cardiac Rehabilitation in Patients With Ventricular Assist Device. J Cardiopulm Rehabil Prev 2022; 42:97-102. [PMID: 34753874 DOI: 10.1097/hcr.0000000000000615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate changes in exercise capacity (EC) and quality of life (QoL) of patients with ventricular assist devices (VADs) during cardiac rehabilitation (CR). METHODS Data from patients with VAD implantation and subsequent CR between 2007 and 2017 were analyzed retrospectively. Measures of the 6-min walk test [6MWT] distance, Functional Independence Measure [FIM], ergometry, MacNew Heart Disease Questionnaire [MNH], and Hospital Anxiety and Depression Scale [HADS] at entry and discharge were examined. RESULTS Data from 110 patients (age 53 ± 12 yr; male 82%) were analyzed. Patients improved during CR significantly in the 6MWT (114 ± 85 m, P < .001), ergometry (20 ± 17 W, P = .002), FIM (8 ± 7 points, P < .001), and MNH (0.8 ± 0.7 points, P < .001). Initial HADS levels were high with a mean value of 9 and did not improve during CR (-0.4 ± 5 points, P = .637). Significant differences of improvements in the 6MWT were observed between left and biventricular VAD (129 ± 90 m vs 85 ± 67 m, P = .043) as well as destination therapy and bridge-to-transplant (184 ± 88 m vs 102 ± 82 m, P = .005). CONCLUSIONS Patients with VAD implantation had statistically and clinically significant improvements in EC and QoL as assessed with the MNH during CR. Patients on destination therapy showed a larger benefit from CR than bridge-to-transplant patients and patients with left VAD improved more than biventricular VAD patients.
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Affiliation(s)
- Tabea Amstad
- Zürcher RehaZentren Klinik Wald, Zürich, Switzerland (Ms Amstad and Dr Hermann); Section of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Berne, Switzerland (Ms Amstad and Dr Taeymans); University Hospital Berne (Inselspital), Bern, Switzerland (Drs Englberger and Mohacsi); Berner Reha Zentrum, Heiligenschwendi, Switzerland (Mr Steiner); and University Heart Center Zürich, UniversityHospital Zurich, Zürich, Switzerland (Drs Wilhelm and Hermann)
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Recommendations for Psychosocial Evaluation of VAD candidates: Adoption, completion, and barriers to implementation. Heart Lung 2021; 51:52-58. [PMID: 34731698 DOI: 10.1016/j.hrtlng.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation. OBJECTIVES Assess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support. METHODS Cross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email. RESULTS Total of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 - 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41). CONCLUSION The 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice.
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Löchel S, Maukel LM, Weidner G, de By TMMH, Spaderna H. Gender differences in psychosocial and clinical characteristics in the European Registry for Patients with Mechanical Circulatory Support. Heart Lung 2021; 50:845-852. [PMID: 34325182 DOI: 10.1016/j.hrtlng.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Not much is known about psychosocial characteristics of men and women receiving continuous flow left ventricular assist devices (CF LVAD). OBJECTIVE To investigate gender differences in clinical and psychosocial (demographic, behavioral, psychological) characteristics in CF LVAD recipients. METHODS We analyzed European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data (N=2395, 16.8% women; 2011 to 2017) and compared pre-implant characteristics in men and women intended for bridge-to-transplant (BTT) or destination therapy (DT). RESULTS Women were underrepresented [DT (n=61): 13.4%; BTT (n=341): 17.6%]. They were more likely to be divorced/separated, widowed, in unstable clinical condition, and non-working (DT only), but less likely to be smokers, to have ischemic cardiomyopathy or diabetes, and younger (BTT only) than men. Missing data were abundant, especially those that reflect psychological characteristics (>87%). CONCLUSION Gender differences were noted, some specific to device strategy. Improved collection of psychosocial characteristics is warranted to elucidate their relationship to future prognosis.
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Affiliation(s)
- Sarah Löchel
- Department of Nursing Science, Section Health Psychology, Trier University, Trier, Germany
| | - Lisa-Marie Maukel
- Department of Nursing Science, Section Health Psychology, Trier University, Trier, Germany
| | - Gerdi Weidner
- Department of Biology - EOS Center, San Francisco State University, San Francisco, CA, USA
| | - Theo M M H de By
- European Association for Cardio-Thoracic Surgery, EACTS House, Windsor, UK
| | - Heike Spaderna
- Department of Nursing Science, Section Health Psychology, Trier University, Trier, Germany.
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Dew MA, Hollenberger JC, Obregon LL, Hickey GW, Sciortino CM, Lockard KL, Kunz NM, Mathier MA, Ramani RN, Kilic A, McNamara DM, Simon MA, Keebler ME, Kormos RL. The Preimplantation Psychosocial Evaluation and Prediction of Clinical Outcomes During Mechanical Circulatory Support: What Information Is Most Prognostic? Transplantation 2021; 105:608-619. [PMID: 32345866 DOI: 10.1097/tp.0000000000003287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychosocial evaluations are required for long-term mechanical circulatory support (MCS) candidates, no matter whether MCS will be destination therapy (DT) or a bridge to heart transplantation. Although guidelines specify psychosocial contraindications to MCS, there is no comprehensive examination of which psychosocial evaluation domains are most prognostic for clinical outcomes. We evaluated whether overall psychosocial risk, determined across all psychosocial domains, predicted outcomes, and which specific domains appeared responsible for any effects. METHODS A single-site retrospective analysis was performed for adults receiving MCS between April 2004 and December 2017. Using an established rating system, we coded psychosocial evaluations to identify patients at low, moderate, or high overall risk. We similarly determined risk within each of 10 individual psychosocial domains. Multivariable analyses evaluated whether psychosocial risk predicted clinical decisions about MCS use (DT versus bridge), and postimplantation mortality, transplantation, rehospitalization, MCS pump exchange, and standardly defined adverse medical events (AEs). RESULTS In 241 MCS recipients, greater overall psychosocial risk increased the likelihood of a DT decision (odds ratio, 1.76; P = 0.017); and postimplantation pump exchange and occurrence of AEs (hazard ratios [HRs] ≥ 1.25; P ≤ 0.042). The individual AEs most strongly predicted were cardiac arrhythmias and device malfunctions (HRs ≥ 1.39; P ≤ 0.032). The specific psychosocial domains predicting at least 1 study outcome were mental health problem severity, poorer medical adherence, and substance use (odds ratios and HRs ≥ 1.32; P ≤ 0.010). CONCLUSIONS The psychosocial evaluation predicts not only clinical decisions about MCS use (DT versus bridge) but important postimplantation outcomes. Strategies to address psychosocial risk factors before or soon after implantation may help to reduce postimplantation clinical risks.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer C Hollenberger
- Department of Social Work, Grove City College, Grove City, PA
- School of Social Work, Baylor University, Dallas, TX
| | - Laura L Obregon
- Health Care Policy and Management Program, Carnegie Mellon University, Pittsburgh, PA
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Gavin W Hickey
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Christopher M Sciortino
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Kathleen L Lockard
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Nicole M Kunz
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Michael A Mathier
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ravi N Ramani
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Arman Kilic
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Marc A Simon
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mary E Keebler
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert L Kormos
- Heart and Vascular Institute, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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13
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A systematic review of psychosocial design considerations for the next generation of mechanical circulatory support. Heart Lung 2021; 50:397-406. [PMID: 33621838 DOI: 10.1016/j.hrtlng.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Biomedical engineers are developing new mechanical circulatory support pumps. Clinicians are generating and analysing new evidence for their prescription and management. Industrial designers are generating usable solutions for wearable components and controllers. However, psychosocial considerations may be falling between the cracks of the three disciplines because of their multi-faceted nature. OBJECTIVES This article seeks to identify psychosocial needs raised in previous work, re-frame them as needs for future products and services, and discuss routes to solutions. METHODS SLR extracted 225 statements on psychosocial considerations from 42 included articles. 23 codes were inductively generated and applied to relevant datapoints. Codes were consolidated under 4 main themes and re-framed as solvable problems. RESULTS Identified themes: expanded remote care, improved multidisciplinary management tools, creating easier interactions; and extending patient engagement. CONCLUSIONS Design-driven methods have been used to solve analogous problems in other contexts and can address the identified psychosocial problems if implemented fully.
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Yilmaz Kafali H, Kalyoncu T, Ozbaran B, Kalyoncu E, Tuncer ON, Ozturk P, Engin C, Yagdi T, Ulger Z, Atay Y, Ozbaran M. Association between caregivers' coping and children's psychiatric symptoms in the heart transplantation process: A pilot study. Artif Organs 2020; 45:354-363. [PMID: 33090474 DOI: 10.1111/aor.13839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022]
Abstract
Our aim was to investigate whether there is an association between caregivers' coping and children's psychiatric symptoms and quality of life in adolescent heart transplant (HTx) recipients and HTx candidates with left ventricular assist device (LVAD). Fourteen patients were recruited for this pilot study (HTx (n = 8), LVAD (n = 6)). Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS) was administered to detect the psychiatric diagnosis of patients. Children's Depression Inventory (CDI), State-Trait Anxiety Inventory, and Pediatric Quality of Life Inventory (PedsQL) were completed by adolescents; Brief Coping Styles Inventory by their caregivers. Six of the participants had an internalizing disorder. Optimistic coping strategy score was significantly higher in the caregivers of adolescents without an internalizing disorder than caregivers of those with an internalizing disorder (U = 2.500, P = .005). Utilizing Spearman's correlation, caregivers' optimistic approach (rho = -0.736, P = .004), and self-confident approach (rho = -0.634, P = .020) had significant negative correlations with children's CDI scores. Moreover, caregivers' optimistic approach score had a significant positive correlation with children's PedsQL score (rho = 0.563, P = .045). According to our preliminary results, it seems that caregivers' optimistic and self-confident coping strategies may be associated with fewer internalizing symptoms and a better quality of life in adolescents in the HTx process. A future multicentered longitudinal study will be planned to assess the effect of caregivers' coping strategies on the psychological adjustment of these children.
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Affiliation(s)
- Helin Yilmaz Kafali
- Department of Child and Adolescent Psychiatry, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Tugba Kalyoncu
- Department of Child and Adolescent Psychiatry, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burcu Ozbaran
- Department of Child and Adolescent Psychiatry, Ege University School of Medicine, Izmir, Turkey
| | - Emir Kalyoncu
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Osman Nuri Tuncer
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Pelin Ozturk
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Cagatay Engin
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Zulal Ulger
- Department of Pediatric Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Yuksel Atay
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Ozbaran
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
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15
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DeFilippis EM, Breathett K, Donald EM, Nakagawa S, Takeda K, Takayama H, Truby LK, Sayer G, Colombo PC, Yuzefpolskaya M, Uriel N, Farr MA, Topkara VK. Psychosocial Risk and Its Association With Outcomes in Continuous-Flow Left Ventricular Assist Device Patients. Circ Heart Fail 2020; 13:e006910. [PMID: 32894983 DOI: 10.1161/circheartfailure.120.006910] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advanced heart failure therapies such as left ventricular assist device (LVAD) implantation require intricate follow-up and complex care. We sought to explore the burden of psychosocial risk factors among patients with LVAD and their impact on postimplant outcomes using the Interagency Registry for Mechanically Assisted Circulatory Support. METHODS Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support requiring durable LVAD between 2008 and 2017 were included. Individuals were determined to have psychosocial risk if they had one of the following: (1) limited social support; (2) limited cognition; (3) substance abuse (alcohol and drug); (4) severe psychiatric disease (including major depression and other major psychiatric diagnosis); and (5) repeated noncompliance. Univariate and multivariate Cox proportional hazard regression models were used to analyze predictors of survival and complications. RESULTS A total of 15 403 continuous-flow LVAD recipients were included. A total of 3163 (20.5%) had one or more psychosocial risk factors. The most prevalent psychosocial risk factor was substance abuse in 1941 (12.6%) recipients. Patients with psychosocial risk factors were significantly younger at LVAD implant, less likely to be White, and less likely to be female compared with those without psychosocial risk, P<0.001 for all. Patients with psychosocial risk were significantly more likely to receive an LVAD as destination therapy, P<0.001. In adjusted models, patients with psychosocial risk were at increased hazards for device-related infection, gastrointestinal bleeding, pump thrombosis, and readmission and reduced hazards for cardiac transplantation (P<0.05 for all). There was no statistically significant difference in survival on pump support or stroke. CONCLUSIONS Psychosocial risk is an important component of patient selection for advanced heart failure therapies. Addressing these specific components may help improve access to advanced therapies and post-LVAD outcomes.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Department of Medicine, Sarver Heart Center, University of Arizona, Tucson (K.B.)
| | - Elena M Donald
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Shunichi Nakagawa
- Adult Palliative Care, Department of Medicine (S.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Lauren K Truby
- Division of Cardiology, Duke University Medical Center, Durham, NC (L.K.T.)
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Nir Uriel
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY
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16
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Okam NA, Ahmad W, Rana D, Torrilus C, Jahan N, Sedrakyan S. Psychological Spectrum Experienced by Heart Failure Patients After Left Ventricular Assist Device Implantation. Cureus 2020; 12:e9671. [PMID: 32923266 PMCID: PMC7485994 DOI: 10.7759/cureus.9671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Depression and anxiety disorders are prevalent in patients with heart failure. They are associated with adverse effects such as rapid disease progression, poor medication compliance, low quality of life and increased mortality rate. The current literature review aims to provide an overview of the overall rate of depression in patients who receive left ventricular assist device (LVAD) implantation and identify the psychological phases that these individuals experienced peri- and post-LVAD implantation. A PubMed search using regular and Medical Subject Headings (MeSH) keywords identified 239 articles. After applying inclusion/exclusion criteria, removal of duplicate studies, and careful review of articles, 40 studies provided relevant information on our primary end-point. These 40 studies selected include 13 paid articles with abstracts and 27 free full-text articles comprising eight prospective cohort studies, five retrospective cohort studies, six cross-sectional studies, one qualitative study, one randomized clinical trial, one systematic review, four literature reviews, and one practice guide. Our review shows that patients experienced different psychological phases after LVAD implantation. However, as the time from implantation progressed, these patients showed a significant improvement in depression, anxiety, and health-related quality of life.
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Affiliation(s)
- Nkechi A Okam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Wiqas Ahmad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dibyata Rana
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chenet Torrilus
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Surik Sedrakyan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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17
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Characteristics, Therapeutic Needs, and Scope of Patients With a Continuous-Flow Left Ventricular Device Entering Cardiac Rehabilitation: A RETROSPECTIVE ANALYSIS. J Cardiopulm Rehabil Prev 2020; 39:91-96. [PMID: 29952811 DOI: 10.1097/hcr.0000000000000342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND With an increasing number of left ventricular assist devices (LVADs) being implanted, the need for adequate cardiac rehabilitation (CR) regimens meeting the special needs of these patients arises. Only a few studies have reported experience gained on this topic. Structured CR strategies are poorly implemented. The aim was to evaluate the characteristics, therapeutic needs, and scope of LVAD patients at admission to CR within a greater cohort in order to identify their special CR needs. METHODS Retrospective single-center study; 69 LVAD patients (50.7 ± 13.6 y; 59 male; 48 HVAD; 21 HeartMate II) who completed first inpatient CR were included. Patient records were used to document relevant medical information (including the results of a 6-min walk test and a maximal isometric strength test for quadriceps femoral muscles in both legs) and the International Classification of Functioning, Disability and Health for classification of health and health-related domains. RESULTS Patient characteristics demonstrated a heterogeneous group: CR was started 44 ± 38.6 d after implantation; CR duration was 28 ± 9.7 d. Despite similar etiology, physical and psychological condition was diverse, although, overall a high degree of impairment was present, especially in the body function (79.7%) and activity and participation (95.7%) domains. The results demonstrated the need for a highly individualized approach in the somatic and also in the education, psychosocial, and social therapeutic regimes. CONCLUSION The results demonstrate a heterogeneous group with a high level of impairment and special needs in many CR domains. The development and evaluation of a special highly individualized approach of CR, which meets the special needs of these patients, is needed.
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18
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Suarez L, Dunlay SM, Schettle SD, Stulak JM, Staab JP. Associations of depressive symptoms with outcomes in patients implanted with left ventricular assist devices. Gen Hosp Psychiatry 2020; 64:93-98. [PMID: 32008725 DOI: 10.1016/j.genhosppsych.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation. METHODS We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities. RESULTS Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation. CONCLUSION Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.
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Affiliation(s)
- Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America; Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Sarah D Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
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19
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Coping, Mood, Quality of Life, and Outcomes in Recipients of Left Ventricular Assist Devices: A Cluster Analysis. Psychosom Med 2020; 81:192-199. [PMID: 30625121 DOI: 10.1097/psy.0000000000000658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Left ventricular assist devices (LVADs) are increasingly used for temporary circulatory support until transplant or as destination therapy for patients with end-stage heart failure. Understanding patients' attitudes and resources is crucial to support them. METHODS Sixty-one LVAD recipients (55 [10] years, 10% women, 15% destination therapy) participating in cardiac rehabilitation (CR) postimplant underwent assessment of coping styles (Coping Orientation for Problem Experiences), quality of life (Medical Outcomes Study Short-Form 36, Minnesota Living with Heart Failure Questionnaire), and mood (Hospital Anxiety and Depression Scale). RESULTS Cluster analysis identified two homogeneous groups: C1 (n = 18) patients had higher anxiety (9.6 [5.0] versus 4.0 [2.7], p < .001), depression (10 [3.0] versus 4 [2.7], p < .001), and avoidant coping (29 [5.2] versus 21.2 [3.8], p < .001) scores and worse quality of life (Short-Form 36 of the Medical Outcomes Study Physical Component Scale 31 [5.3] versus 35.6 [6.9], p < .001; Mental Component Scale 34.3 [6.8] versus 50.3 [8], p < .001; MLHFQ physical 26 [7.2] versus 13.9 [8.2], p < .001; emotional 17.7 [3.4] versus 3.86 [3.2], p < .001) than C2 participants (n = 43). During 31 (15-54) months, 20 patients (33%) died. By Cox multivariable analysis, after adjustment for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at surgery, and meters walked during 6 minutes at CR discharge, C1 was associated with mortality (hazard ratio = 2.858; 95% confidence interval = 1.102-7.408, p = .031; model χ = 7.286, df = 5, p = .20). Survival was 44% in C1 and 77% in C2 (log-rank p = .033). CONCLUSIONS Among patients discharged from CR after LVAD implant, one third show a profile characterized by worse perceived quality of life, mood disorders, and dysfunctional coping that is associated with long-term mortality, and these factors are potential targets for post-LVAD intensive support.
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20
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Thorac Cardiovasc Surg 2020; 159:865-896. [DOI: 10.1016/j.jtcvs.2019.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Kirklin JK, Pagani FD, Goldstein DJ, John R, Rogers JG, Atluri P, Arabia FA, Cheung A, Holman W, Hoopes C, Jeevanandam V, John R, Jorde UP, Milano CA, Moazami N, Naka Y, Netuka I, Pagani FD, Pamboukian SV, Pinney S, Rogers JG, Selzman CH, Silverstry S, Slaughter M, Stulak J, Teuteberg J, Vierecke J, Schueler S, D'Alessandro DA. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant 2020; 39:187-219. [PMID: 31983666 DOI: 10.1016/j.healun.2020.01.1329] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
| | | | - Daniel J Goldstein
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | | | - Anson Cheung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - William Holman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Charles Hoopes
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | - Ulrich P Jorde
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Nader Moazami
- Langone Medical Center, New York University, New York, NY
| | - Yoshifumi Naka
- Columbia University College of Physicians & Surgeons, New York, NY
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Salpy V Pamboukian
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | | | | | | | | | - John Stulak
- Mayo Clinic College of Medicine and Science, Rochester, Minn
| | | | | | | | - Stephan Schueler
- Department for Cardiothoracic Surgery, Newcastle upon Tyne Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David A D'Alessandro
- Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass
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22
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Kato NP, Jaarsma T, Casida JM, Lee CS, Strömberg A, Gal TB. Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation. Prog Transplant 2019; 29:335-343. [DOI: 10.1177/1526924819874358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.Methods:We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.Results:A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.Conclusion:The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.
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Affiliation(s)
- Naoko P. Kato
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Sweden
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Japan
| | - Tiny Jaarsma
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Sweden
| | - Jesus M. Casida
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Christopher S. Lee
- Oregon Health and Science University School of Nursing and Knight Cardiovascular Institute, Portland, OR, USA
- Boston College, Willian F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Division of Nursing Science, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel
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Cagliostro MATTHEW, BROMLEY ANDREW, TING PETER, DONEHEY JOHN, FERKET BART, PARKS KIRA, PALUMBO ELYSE, MANCINI DONNA, ANYANWU ANELECHI, PAWALE AMIT, PINNEY SEAN, MOSS NOAH, LALA ANURADHA. Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients. J Card Fail 2019; 25:735-743. [DOI: 10.1016/j.cardfail.2019.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
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24
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Voltolini A, Salvato G, Frigerio M, Cipriani M, Perna E, Pisu M, Mazza U. Psychological outcomes of left ventricular assist device long‐term treatment: A 2‐year follow‐up study. Artif Organs 2019; 44:67-71. [DOI: 10.1111/aor.13531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Alessandra Voltolini
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Gerardo Salvato
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
- Department of Brain and Brain and Behavioral Sciences University of Pavia Pavia Italy
- Cognitive Neuropsychology Centre ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
- NeuroMi Milan Center for Neuroscience Milan Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Manlio Cipriani
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Enrico Perna
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Mirella Pisu
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Umberto Mazza
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
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Clancy MJ, Jessop AB, Eisen H. Assessment of pre-operative psychosocial function among people receiving left ventricular assist devices: A national survey of US LVAD programs. Heart Lung 2019; 48:302-307. [DOI: 10.1016/j.hrtlng.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/14/2019] [Accepted: 02/23/2019] [Indexed: 11/26/2022]
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26
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Bui QM, Allen LA, LeMond L, Brambatti M, Adler E. Psychosocial Evaluation of Candidates for Heart Transplant and Ventricular Assist Devices: Beyond the Current Consensus. Circ Heart Fail 2019; 12:e006058. [DOI: 10.1161/circheartfailure.119.006058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools—including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale—were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.
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Affiliation(s)
- Quan M. Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Larry A. Allen
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (L.A.A.)
| | - Lisa LeMond
- Department of Cardiology, Mayo Clinic Arizona, Phoenix (L.L.)
| | - Michela Brambatti
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
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Bui QM, Braun OO, Brambatti M, Gernhofer YK, Hernandez H, Pretorius V, Adler E. The value of Stanford integrated psychosocial assessment for transplantation (SIPAT) in prediction of clinical outcomes following left ventricular assist device (LVAD) implantation. Heart Lung 2019; 48:85-89. [DOI: 10.1016/j.hrtlng.2018.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023]
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Eickmeyer SM, Barker KD, Sayyad A, Rydberg L. The Rehabilitation of Patients With Advanced Heart Failure After Left Ventricular Assist Device Placement: A Narrative Review. PM R 2019; 11:64-75. [PMID: 29929019 DOI: 10.1016/j.pmrj.2018.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/17/2018] [Indexed: 01/18/2023]
Abstract
Because more patients with advanced heart failure are receiving a left ventricular assist device (LVAD) as destination therapy or a bridge to transplantation, there is increasing attention on functional outcomes and quality of life after LVAD implantation. Rehabilitation providers in the acute inpatient rehabilitation setting increasingly will treat patients with an LVAD and should understand the exercise physiology, medical management, rehabilitation considerations, and outcomes after rehabilitation for patients with an LVAD. The purpose of this article is to provide the physiatrist with a comprehensive understanding of the rehabilitation of patients with advanced heart failure and LVAD implantation. Changes in relevant organ system physiology and exercise physiology after LVAD are summarized. Safety of rehabilitation and program considerations for acute inpatient rehabilitation are reviewed. Recommendations for medical management and prevention of secondary complications seen in patients with an LVAD are outlined. A discussion of outcomes after acute inpatient rehabilitation, the dual diagnosis of stroke and LVAD placement, and long-term cognitive, functional, and quality-of-life outcomes after LVAD placement is presented.
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Affiliation(s)
- Sarah M Eickmeyer
- Department of Rehabilitation Medicine, University of Kansase-Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160
| | - Kim D Barker
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anjum Sayyad
- Department of Physical Medicine and Rehabilitation, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; Marianjoy Rehabilitation Hospital, Wheaton, Illinois
| | - Leslie Rydberg
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Shirley Ryan AbilityLab, Chicago, Illinois
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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Halkar M, Nowacki AS, Kendall K, Efeovbokhan N, Gorodeski EZ, Moazami N, Starling RC, Young JB, Lee S, Tang WW. Utility of the Psychosocial Assessment of Candidates for Transplantation in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation. Prog Transplant 2018; 28:220-225. [DOI: 10.1177/1526924818781559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Psychosocial assessment of patients comprises an important element in the selection process of appropriate candidates for left ventricular assist device (LVAD) implantation. We sought to determine the association of the well-validated psychosocial assessment of candidates for transplantation (PACT) scale to clinical outcomes post-LVAD implantation. Materials and Methods: The PACT scale was used retrospectively to reconstruct psychosocial profiles of all patients who underwent a continuous-flow LVAD implantation for all indications at our institution between March 2008 and August 2012 (N = 230). Psychosocial elements including social support, psychological health, lifestyle factors, comprehension of the operation, and follow-up were evaluated. The primary outcome was overall survival, and the secondary outcomes were hospital readmission, pump thrombosis, hemolysis, gastrointestinal (GI) bleeding, and LVAD driveline infections. Results: The mean age of patients was 55.3 years, with 83% being male; 58% (N = 135) were bridge to transplant and 42% (N = 95) were destination therapy. Up to 1-year post-LVAD implant, there were no statistical differences among the 5 PACT candidate groups in terms of survival ( P = .79), hospital readmissions ( P = .55), suspected or confirmed pump thrombosis ( P = .31), hemolysis ( P = .43), GI bleeding ( P = .71), or driveline infections ( P = .06). Conclusions: In this single-center retrospective review, post hoc reconstruction of psychosocial profiles using the PACT scale and independent assessment of postimplant outcomes, including survival and adverse events, did not show any association. However, given the small number of patients in the low score PACT groups as well as limited duration of follow-up, further studies are required to elucidate the association.
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Affiliation(s)
- Meghana Halkar
- Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amy S. Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Kay Kendall
- Department of Social Work, Cleveland Clinic, Cleveland, OH, USA
| | - Nephertiti Efeovbokhan
- Department of Cardiovascular Medicine, NEA Baptist Memorial Hospital, Jonesboro, AR, USA
| | - Eiran Z. Gorodeski
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nader Moazami
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
| | | | - James B. Young
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sangjin Lee
- Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids Michigan, MI, USA
| | - W.H. Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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A Ventricular Assist Device Recipient and Suicidality: Multidisciplinary Collaboration With a Psychiatrically Distressed Patient. J Cardiovasc Nurs 2018; 32:135-139. [PMID: 26422637 DOI: 10.1097/jcn.0000000000000293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ventricular assist device (VAD) recipients are at high risk of depression and anxiety, and poor psychosocial functioning is associated with worse medical outcomes. PURPOSE We present a case of a 31-year-old depressed patient who demonstrated passive suicidal behavior through multiple episodes of noncompliance, including temporarily discontinuing warfarin (Coumadin) several months after VAD implantation. The patient's psychosocial and medical histories and outcomes are presented. CONCLUSIONS This case underscores the importance of pre-VAD as well and ongoing psychosocial evaluation and management for this unique patient population. CLINICAL IMPLICATIONS Medical teams who are treating patients with cardiovascular disease who are under consideration for VAD or heart transplantation need to be aware of the multitude of ways in which patients can express depressed and suicidal mood and work with a multidisciplinary team to treat such symptoms to optimize patients' success with VAD/heart transplantation.
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Newman L. The Psychosocial Treadmill: the Road to Improving High-risk Behavior in Advanced Therapy Candidates. Curr Heart Fail Rep 2018; 15:70-74. [DOI: 10.1007/s11897-018-0380-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lundgren S, Poon CYM, Selim A, Lowes BD, Zolty R, Burdorf A, Potashnik-Peled Y, Moulton MJ, Um JY, Raichlin E. Depression and anxiety in patients undergoing left ventricular assist device implantation. Int J Artif Organs 2017; 41:0. [PMID: 29099540 DOI: 10.5301/ijao.5000650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and anxiety are associated with a worse prognosis in heart failure patients. The aim of this study was to identify the prevalence of depression and anxiety in left ventricular assist device (LVAD) candidates and assess their effect on post-LVAD outcomes. METHODS Based on the pre-LVAD psychological assessment, the total cohort of 246 patients were divided into 4 groups: 1) no depression or anxiety (NDep&Anx group, n = 138); 2) isolated depression (Dep group, n = 42); 3) isolated anxiety (Anx group, n = 32), and 4) combined depression and anxiety (Dep&Anx group, n = 34). RESULTS The Dep&Anx group was associated with higher prevalence of female gender (p = 0.03), higher body mass index (p = 0.03), elevated E/E' (p = 0.003), and increased Model For End-Stage Liver Disease (MELD) XI score (p = 0.04) prior to LVAD as compared to the other 3 subgroups. The prevalence of other major psychiatric disorders (p = 0.03) and narcotic dependence (p = 0.004) was higher in the Dep&Anx group. Post-LVAD implantation, heart rate and filling pressures were elevated and readmission rate was higher (p = 0.001) in the Dep&Anx group. There was no difference in survival between the groups (p = 0.40, Log-Rank test). CONCLUSIONS Pre-existing anxiety and depression was associated with worse HF pre- and post-LVAD implantation and higher readmissions rate after LVAD implantation.
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Affiliation(s)
- Scott Lundgren
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | | | - Ahmed Selim
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Brian D Lowes
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Ronald Zolty
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Adam Burdorf
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Yael Potashnik-Peled
- Sheba Medical Center Heart Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv - Israel
| | - Michael J Moulton
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE - USA
| | - John Y Um
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE - USA
| | - Eugenia Raichlin
- Department of Cardiology, Loyola University Medical Center, Maywood, IL - USA
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35
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Reduced Anxiety and Depression in Patients With Advanced Heart Failure After Left Ventricular Assist Device Implantation. PSYCHOSOMATICS 2017; 58:406-414. [DOI: 10.1016/j.psym.2017.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/19/2022]
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Bruce CR, Minard CG, Wilhelms L, Abraham M, Amione-Guerra J, Pham L, Grogan SD, Trachtenberg B, Smith ML, Bruckner BA, Estep JD, Kostick KM. Caregivers of Patients With Left Ventricular Assist Devices. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.002879. [DOI: 10.1161/circoutcomes.116.002879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022]
Abstract
Background—
How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers’ psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients’ post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support–defined morbidity events.
Methods and Results—
We retrospectively reviewed and recorded social workers’ clinical assessments of adult patients implanted with durable continuous-flow LVADs as bridge to transplant, destination therapy, or bridge to decision from January 2010 to December 2014. Associations between caregiver characteristics and patient mortality and morbidity events were analyzed using Kaplan–Meier curves and Cox proportional hazards regression. Patient follow-up time was calculated as the time from hospital discharge until the earliest among death with LVAD, transplant, or the last day of the study (December 31, 2015). Patients were censored for death with LVAD at the time of transplant or the last day of the study. A total of 96 LVAD recipients were included in this study. Having a caregiver who understands the severity of the illness and options available to the patient (as determined and documented by the social worker;
P
=0.01), a caregiver who has identified a backup plan (
P
=0.02), and a caregiver who is able to provide logistical support (
P
=0.04) significantly mitigated risk of death. The risk of death for an LVAD patient was also significantly lower among those who have at least 1 adult child who lives within 50 miles (
P
=0.03) and those who have an extended family who can care for the patient (
P
=0.03). The risk of death was 3.1× more likely among patients who live alone compared with those who do not live alone (
P
=0.04). No caregiver characteristics were significantly associated with morbidity.
Conclusions—
This exploratory, hypothesis-generating study suggests that mortality after LVAD placement is impacted by caregiver understanding of patient severity of illness and caregiver presence. This study provides initial evidence to support further work in understanding the associations between caregivers and LVAD patients, as well as interventions that may improve patient outcomes.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02248974.
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Affiliation(s)
- Courtenay R. Bruce
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Charles G. Minard
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - L.A. Wilhelms
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Mackenzie Abraham
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Javier Amione-Guerra
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Linda Pham
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Sherry D. Grogan
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Barry Trachtenberg
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Martin L. Smith
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Brian A. Bruckner
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Jerry D. Estep
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Kristin M. Kostick
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
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Tei C, Imamura T, Kinugawa K, Inoue T, Masuyama T, Inoue H, Noike H, Muramatsu T, Takeishi Y, Saku K, Harada K, Daida H, Kobayashi Y, Hagiwara N, Nagayama M, Momomura S, Yonezawa K, Ito H, Gojo S, Akaishi M, Miyata M, Ohishi M. Waon Therapy for Managing Chronic Heart Failure - Results From a Multicenter Prospective Randomized WAON-CHF Study. Circ J 2016; 80:827-34. [PMID: 27001189 DOI: 10.1253/circj.cj-16-0051] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Waon therapy improves heart failure (HF) symptoms, but further evidence in patients with advanced HF remains uncertain. METHODS AND RESULTS In 19 institutes, we prospectively enrolled hospitalized patients with advanced HF, who had plasma levels of B-type natriuretic peptide (BNP) >500 pg/ml on admission and BNP >300 pg/ml regardless of more than 1 week of medical therapy. Enrolled patients were randomized into Waon therapy or control groups. Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60℃ for 15 min, followed by bed rest for 30 min covered with a blanket. The primary endpoint was the ratio of BNP before and after treatment. In total, 76 Waon therapy and 73 control patients (mean age 66 years, men 61%, mean plasma BNP 777 pg/ml) were studied. The groups differed only in body mass index and the frequency of diabetes. The plasma BNP, NYHA classification, 6-min walk distance (6MWD), and cardiothoracic ratio significantly improved only in the Waon therapy group. Improvements in NYHA classification, 6MWD, and cardiothoracic ratio were significant in the Waon therapy group, although the change in plasma BNP did not reach statistical significance. No serious adverse events were observed in either group. CONCLUSIONS Waon therapy, a holistic soothing warmth therapy, showed clinical advantages in safety and efficacy among patients with advanced HF.
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Yost GL, Bhat G, Ibrahim KN, Karountzos AG, Chandrasekaran M, Mahoney E. Psychosocial Evaluation in Patients Undergoing Left Ventricular Assist Device Implantation Using the Transplant Evaluation Rating Scale. PSYCHOSOMATICS 2016; 57:41-6. [DOI: 10.1016/j.psym.2015.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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Snipelisky D, Stulak JM, Schettle SD, Sharma S, Kushwaha SS, Dunlay SM. Psychosocial characteristics and outcomes in patients with left ventricular assist device implanted as destination therapy. Am Heart J 2015; 170:887-94. [PMID: 26542496 DOI: 10.1016/j.ahj.2015.08.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychosocial factors impact survival in patients undergoing cardiac transplantation, but it is unclear whether they affect outcomes in patients undergoing left ventricular assist device (LVAD) implantation as destination therapy (DT). METHODS Patients undergoing DT LVAD at the Mayo Clinic in Rochester, MN, from February 2007 to December 2013 were included. Psychosocial characteristics at the time of LVAD implantation were abstracted from the medical record. Andersen-Gill and Cox models were used to examine the association between psychosocial characteristics and all-cause readmission and death, respectively. Patients were censored at death or last follow-up through September 2014. RESULTS Among 136 patients (mean age. 64 years; 17% female), most were married/living with a partner (82%), half (55%) had post-high school education, and a history of depression was common (32%). Although most patients were former tobacco users (60%) only a small proportion were current tobacco users (10%) and had a history of alcohol abuse (16%) or illegal drug use (7%). After a mean follow-up of 2.2 ± 1.8 years, 78% of patients had been readmitted (range, 0-14 per person) and 49% had died. There were no statistically significant differences in the risk of death according to psychosocial characteristics. However, current tobacco users had lower risk of readmission (adjusted HR, 0.57; 95% CI, 0.38-0.88), while illegal drug use (HR, 1.55; 95% CI, 1.01-2.35) and depression (HR, 1.77; 95% CI, 1.40-2.22) were associated with higher readmission risk. CONCLUSIONS Psychosocial characteristics are not significant predictors of death but are associated with readmission risk after DT LVAD.
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