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Nguyen DD, Spertus JA, Benton MC, Thomas M, Jones PG, Andrei AC, Wu T, Baldridge AS, Grady KL. Association of Patient Reported Outcomes With Caregiver Burden in Older Patients With Advanced Heart Failure: Insights From the SUSTAIN-IT Study. Circ Heart Fail 2024; 17:e011705. [PMID: 38910557 DOI: 10.1161/circheartfailure.124.011705] [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: 02/13/2024] [Accepted: 04/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Caregivers of patients with advanced heart failure may experience burden in providing care, but whether changes in patient health status are associated with caregiver burden is unknown. METHODS This observational study included older patients (60-80 years old) receiving advanced surgical heart failure therapies and their caregivers at 13 US sites. Patient health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores are better). Caregiver burden was assessed using the Oberst Caregiving Burden Scale, which measures time on task (OCBS-time) and task difficulty (OCBS-difficulty; range, 1-5; lower scores are better). Measurements occurred before surgery and 12 months after in 3 advanced heart failure cohorts: patients receiving long-term left ventricular assist device support; heart transplantation with pretransplant left ventricular assist device support; and heart transplantation without pretransplant left ventricular assist device support. Multivariable linear regression was used to identify predictors of change in OCBS-time and OCBS-difficulty at 12 months. RESULTS Of 162 caregivers, the mean age was 61.0±9.4 years, 139 (86%) were female, and 140 (86%) were the patient's spouse. At 12 months, 99 (61.1%) caregivers experienced improved OCBS-time, and 61 (37.7%) experienced improved OCBS-difficulty (versus no change or worse OCBS). A 10-point higher baseline 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.09 [95% CI, -0.14 to -0.03]; P<0.001) and OCBS-difficulty (β=-0.08 [95% CI, -0.12 to -0.05]; P<0.001). Each 10-point improvement in the 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.07 [95% CI, -0.12 to -0.03]; P=0.002) and OCBS-difficulty (β=-0.09 [95% CI, -0.12 to -0.06]; P<0.001). CONCLUSIONS Among survivors at 12 months, baseline and change in patient health status were associated with subsequent caregiver time on task and task difficulty in dyads receiving advanced heart failure surgical therapies, highlighting the potential for serial 12-item Kansas City Cardiomyopathy Questionnaire assessments to identify caregivers at risk of increased burden. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT02568930.
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Affiliation(s)
- Dan D Nguyen
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - John A Spertus
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Mary C Benton
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Merrill Thomas
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Philip G Jones
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Adin-Cristian Andrei
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Tingqing Wu
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Abigail S Baldridge
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Kathleen L Grady
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
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2
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Chuzi S, Wilcox JE, Kao A, Spertus JA, Hsich E, Dew MA, Yancy CW, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Wu T, Andrei AC, Baldridge A, Grady KL. Change in Caregiver Health-Related Quality of Life From Before to Early After Surgery: SUSTAIN-IT Study. Circ Heart Fail 2023; 16:e010038. [PMID: 37345518 PMCID: PMC10482357 DOI: 10.1161/circheartfailure.122.010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Information about health-related quality of life (HRQOL) among caregivers of older patients with heart failure who receive heart transplantation (HT) and mechanical circulatory support (MCS) is sparse. We describe differences and factors associated with change in HRQOL before and early post-surgery among caregivers of older heart failure patients who underwent 3 surgical therapies: HT with pretransplant MCS (HT MCS), HT without pretransplant MCS (HT non-MCS), and long-term MCS. METHODS Caregivers of older patients (60-80 years) from 13 US sites completed the EQ-5D-3 L visual analog scale (0 [worst]-100 [best] imaginable health state) and dimensions before and 3 and 6 months post-surgery. Analyses included linear regression, t tests, and nonparametric tests. RESULTS Among 227 caregivers (HT MCS=54, HT non-MCS=76, long-term MCS=97; median age 62.7 years, 30% male, 84% White, 83% spouse/partner), EQ-5D visual analog scale scores were high before (84.8±14.1) and at 3 (84.7±13.0) and 6 (83.9±14.7) months post-surgery, without significant differences among groups or changes over time. Patient pulmonary hypertension presurgery (β=-13.72 [95% CI, -21.07 to -6.36]; P<0.001) and arrhythmia from 3 to 6 months post-operatively (β=-14.22 [95% CI, -27.41 to -1.02]; P=0.035) were associated with the largest decrements in caregiver HRQOL; patient marital/partner status (β=6.21 [95% CI, 1.34-11.08]; P=0.013) and presurgery coronary disease (β=8.98 [95% CI, 4.07-13.89]; P<0.001) were associated with the largest improvements. CONCLUSIONS Caregivers of older patients undergoing heart failure surgeries reported overall high HRQOL before and early post-surgery. Understanding factors associated with caregiver HRQOL may inform decision-making and support needs. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02568930.
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Affiliation(s)
| | | | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO
| | | | | | | | | | | | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis, MN
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3
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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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Assessment of Caregiver Burden Prior to Implantation of Left Ventricular Assist Device: A National Survey. J Heart Lung Transplant 2023; 42:689-692. [PMID: 36973094 DOI: 10.1016/j.healun.2023.02.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Guidelines recommend incorporation of caregiver burden assessment and list significant caregiver burden as a relative contraindication when considering left-ventricular assist device (LVAD) implantation. METHODS To assess national practices regarding caregiver burden assessment, in 2019 we administered a 47-item survey to LVAD clinicians using 4 convenience samples. RESULTS Responses were obtained from 191 registered nurses, 109 advance practice providers, 71 physicians, 59 social workers, and 40 others representing 132 LVAD programs; 125 of 173 total United States programs were included in the final analysis. While most programs (83.2%) assessed caregiver burden, assessment was most frequently conducted informally during social work evaluation (83.2%), with only 8.8% incorporating validated measures of caregiver burden. Larger programs were more likely to use a validated assessment measure (OR 6.68 [1.33-33.52]). CONCLUSIONS Future research should focus on how programs can standardize caregiver burden assessment and how the level of burden may impact patient and caregiver outcomes.
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Jesse MT, Gartrelle K, Bruschwein H, Hug G, LeTarte B, Lerret S, Dew MA. Non-pharmacological interventions engaging organ transplant caregivers: A systematic review. Clin Transplant 2022; 36:e14611. [PMID: 35143701 DOI: 10.1111/ctr.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
Lay-caregivers in organ transplantation (to candidates, recipients, and donors) are essential to pre- and post-operative care, but report significant caregiving-related stressors. This review aims to summarize studies testing non-pharmacological interventions aimed at improving organ transplant caregiver-reported outcomes. METHODS In accordance with PRISMA, we conducted a systematic review (searched PubMed, Embase, Cochrane Central, PsycInfo, and CINAHL, no start-date restriction through 7/1/2021). Quality of comparative studies assessed by ROBS-2 or ROBINS. RESULTS Twelve studies met inclusion. Study designs, interventions, and outcomes varied. Sample sizes were small across caregivers to adult (nine studies, five with caregiver samples ns≤50) and pediatric patients (three studies, caregiver samples ns≤16). Study designs included seven single-arm interventions, two pre-post with comparison cohorts, and three randomized-controlled trials. Eight studies included transplant-specific education as the intervention, an interventional component, or as the comparison group. Outcomes included transplant specific knowledge, mental health, and intervention acceptability. Of the nine pre-post caregiver assessments and/or comparison groups, four studies demonstrated no statistically significant intervention effects. CONCLUSION Few interventions addressing the needs of organ transplant caregivers have been empirically evaluated. Existing interventions were well-received by caregivers. Given complexities of care in transplantation, research is needed evaluating interventions using rigorous trial methodology with adequate samples. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, MI.,Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI.,Academic Internal Medicine, Henry Ford Health System, Detroit, MI
| | | | - Heather Bruschwein
- Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Gina Hug
- Sladen Library, Henry Ford Health System, Detroit, MI
| | | | - Stacee Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
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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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Neo SHS, Ku JSM, Wong GCS, Tan BC, Tan EYW, Tan JYT, Kerk KL, Sim DKL, Sivathasan C, Yoon S. Life Beyond Heart Failure-What Are the Long-Term Challenges, Supportive Care Needs, and Views Toward Supportive Care of Multiethnic Asian Patients With Left Ventricular Assist Device and Their Caregivers? J Pain Symptom Manage 2020; 60:577-587.e1. [PMID: 32251690 DOI: 10.1016/j.jpainsymman.2020.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 11/25/2022]
Abstract
CONTEXT Challenges experienced by patients with the left ventricular assist device (LVAD) and their caregivers during the early period after LVAD implantation are well documented. However, little is known about long-term challenges, supportive care needs, and views toward supportive care of Asian LVAD patients and caregivers. OBJECTIVES We aimed to explore the experiences of multiethnic Asian LVAD patients and caregivers so as to identify their long-term challenges, supportive care needs, and views toward supportive care. METHODS Semistructured interviews with LVAD patients and caregivers were conducted based on the grounded theory approach. Participants were purposively recruited from the inpatient and outpatient settings of the National Heart Center Singapore. RESULTS A total of 30 patients and 11 caregivers participated. More than half of the participants were Chinese (patients 63%; caregivers 64%). Most patients (83%) were males, whereas most caregivers were females (91%). The median duration on support was 31 months and 46 months for patients and caregivers, respectively. The implantation of the LVAD was a significant milestone in their lives and caused long-term changes in multiple domains (physical, financial, social, psychoemotional, and spiritual). Experiencing permanent and recurrent losses over time was particularly challenging. Participants expressed the need for mutual support between patient and caregiver and connectedness with others and society at large. Participants desired holistic supportive care from their health care team. CONCLUSION Asian LVAD patients and caregivers experienced long-term challenges and had unique supportive care needs. Our findings have implications on the design of future interventions and supportive care models.
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Affiliation(s)
- Shirlyn Hui-Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
| | - Jasmine Si Min Ku
- Department of Medical Social Services, National Heart Centre Singapore, Singapore, Singapore
| | | | - Boon Cheng Tan
- Department of Medical Social Services, National Heart Centre Singapore, Singapore, Singapore
| | - Eugene Yong Wei Tan
- Department of Medical Social Services, National Heart Centre Singapore, Singapore, Singapore
| | - Jasmine Yun Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Ka Lee Kerk
- Mechanical Circulatory Support, Heart Lung Unit, National Heart Centre Singapore, Singapore, Singapore
| | | | - Cumaraswamy Sivathasan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Waldenburger N, Steinecke M, Peters L, Jünemann F, Bara C, Zimmermann T. Depression, anxiety, fear of progression, and emotional arousal in couples after left ventricular assist device implantation. ESC Heart Fail 2020; 7:3022-3028. [PMID: 32725771 PMCID: PMC7524127 DOI: 10.1002/ehf2.12927] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/12/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022] Open
Abstract
AIMS Left ventricular assist device (LVAD) is a common treatment option for patients with heart failure waiting for a donor heart. Living with an LVAD is associated with many burdens and worries. Patients often depend on the support of their relatives, usually their spouses. This can also put a strain on the spouses and be associated with psychological stress for both. In couples, communication proves to be an important form of emotional support. Besides verbal aspects of communication, the extent of emotional arousal (f0 ) that is vocally encoded plays an essential role as a non-verbal aspect of communication. This study aims to investigate the psychological impact of LVAD on couples in investigating to what extent depression, anxiety, and fear of progression (FoP) differ between patients and partners, the intrapersonal and interpersonal associations of anxiety, depression, and FoP, and differences in emotional arousal. METHODS AND RESULTS In this cross-sectional study, male LVAD patients and their female partners (N = 21 couples) responded to self-report questionnaires on depression, anxiety, and FoP. Emotional arousal (f0 ) was evaluated during social support interactions between both spouses. Female partners experienced more anxiety than male patients (P = 0.016). No differences occurred in depression (P = 0.967) and FoP (P = 0.084). Regarding intrapersonal associations, for patients, correlations appeared between anxiety and depression (r = 0.859, P = 0.000), anxiety and FoP (r = 0.730, P = 0.000), and depression and FoP (r = 0.608, P = 0.004). For caregivers, correlations appeared between anxiety and depression (r = 0.906, P = 0.000), anxiety and FoP (r = 0.665, P = 0.001), and depression and FoP (r = 0.734, P = 0.000). Regarding interpersonal associations, correlations were found between patient's anxiety and caregiver's anxiety (r = 0.461, P = 0.041), caregiver's depression (r = 0.510, P = 0.018), and caregiver's FoP (r = 0.524, P = 0.015). Non-significant correlations were found for caregiver's anxiety and patient's FoP (r = 0.404, P = 0.078) and patient's depression (r = 0.286, P = 0.236). Patient's depression was associated with caregiver's FoP (r = 0.526, P = 0.017), but not with caregiver's depression (r = 0.337, P = 0.146). No significant correlations were found between caregiver's depression and patient's FoP (r = 0.386, P = 0.084) and patient's depression (r = 0.337, P = 0.146). Patient's and caregiver's FoP showed significant associations (r = 0.482, P = 0.027). Patient's and partner's f0 were interrelated. Patient's f0 was positively related with his own and his partner's psychological distress. Partner's f0 showed associations to her own depression and FoP. CONCLUSIONS Findings indicate that women of LVAD patients are burdened similarly or even to a greater extent than men themselves. Women's psychological distress has an impact on patients' psychological distress and vice versa. Early interventions for both patient and partner represent a necessary intervention target.
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Affiliation(s)
- Nina Waldenburger
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Marnie Steinecke
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Luisa Peters
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Finja Jünemann
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany.,Integrated Research and Treatment Center Transplantation IFB-Tx, Hanover Medical School, Hanover, Germany
| | - Christoph Bara
- Department of Heart-, Thoracic-, Transplant- and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany
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9
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Pak ES, Jones CA, Mather PJ. Ethical Challenges in Care of Patients on Mechanical Circulatory Support at End-of-Life. Curr Heart Fail Rep 2020; 17:153-160. [DOI: 10.1007/s11897-020-00460-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Magasi S, Buono S, Yancy CW, Ramirez RD, Grady KL. Preparedness and Mutuality Affect Quality of Life for Patients With Mechanical Circulatory Support and Their Caregivers. Circ Cardiovasc Qual Outcomes 2019; 12:e004414. [DOI: 10.1161/circoutcomes.117.004414] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susan Magasi
- Department of Occupational Therapy and Department of Disability Studies, University of Illinois at Chicago (S.M.)
| | - Sarah Buono
- Department of Medical Social Sciences (S.B.), Northwestern University, Chicago, IL
| | - Clyde W. Yancy
- Division of Cardiology, Department of Medicine and Department of Medical Social Sciences (C.W.Y.), Northwestern University, Chicago, IL
| | - Ricardo D. Ramirez
- Department of Occupational Therapy, University of Illinois at Chicago (R.D.R.)
| | - Kathleen L. Grady
- Division of Cardiac Surgery, Department of Surgery and Department of Medicine, Feinberg School of Medicine (K.L.G.), Northwestern University, Chicago, IL
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11
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Noonan MC, Wingham J, Taylor RS. 'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review. BMJ Open 2018; 8:e020927. [PMID: 29997137 PMCID: PMC6082485 DOI: 10.1136/bmjopen-2017-020927] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors. DATA ANALYSIS/SYNTHESIS A results-based convergent synthesis was conducted. RESULTS Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time. CONCLUSION Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required. TRIAL REGISTRATION NUMBER CRD42016053412.
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Affiliation(s)
- Miriam Catherine Noonan
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Jennifer Wingham
- Royal Cornwall Hospitals NHS Trust, Research, Development and Innovation, F37, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall & University of Exeter, Exeter, UK
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12
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Quality of life of family caregivers of patients with a left ventricular assist device in Japan. J Cardiol 2018; 71:81-87. [DOI: 10.1016/j.jjcc.2017.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 01/31/2023]
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13
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Bidwell JT, Lyons KS, Mudd JO, Gelow JM, Chien CV, Hiatt SO, Grady KL, Lee CS. Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers. J Cardiovasc Nurs 2017; 32:455-463. [PMID: 27811585 PMCID: PMC5413439 DOI: 10.1097/jcn.0000000000000378] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device. OBJECTIVE The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation. METHODS This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes. RESULTS Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers. CONCLUSIONS This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.
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Affiliation(s)
- Julie T Bidwell
- Julie T. Bidwell, PhD, RN Predoctoral Fellow, Oregon Health & Science University School of Nursing, Portland. Karen S. Lyons, PhD, FGSA Associate Professor, Oregon Health & Science University School of Nursing, Portland. James O. Mudd, MD Associate Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Jill M. Gelow, MD, MPH Assistant Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Christopher V. Chien, MD Assistant Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Shirin O. Hiatt, MPH, MS, RN Research Associate, Oregon Health & Science University School of Nursing, Portland. Kathleen L. Grady, PhD, MS, RN, FAHA, FHSA, FAAN Professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Christopher S. Lee, PhD, RN, FAHA, FHFSA, FAAN Associate Professor, Oregon Health & Science University School of Nursing and Knight Cardiovascular Institute, Portland
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14
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Nicholas Dionne-Odom J, Hooker SA, Bekelman D, Ejem D, McGhan G, Kitko L, Strömberg A, Wells R, Astin M, Metin ZG, Mancarella G, Pamboukian SV, Evangelista L, Buck HG, Bakitas MA. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review. Heart Fail Rev 2017; 22:543-557. [PMID: 28160116 PMCID: PMC5544594 DOI: 10.1007/s10741-017-9597-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize (1) how caregivers influence patients, (2) the consequences of HF for caregivers, and (3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms "heart failure" AND "caregiver." Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5700 caregivers. Research on this population indicates that (1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); (2) caregivers have numerous unmet needs that fluctuate with patients' unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and (3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to progress the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
| | - Stephanie A Hooker
- Department of Psychology, University of Colorado, Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - David Bekelman
- Veterans Affairs Eastern Colorado Health Care System, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, 1055 Clermont Street, Research 151, Denver, CO, 80220, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Gwen McGhan
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Lisa Kitko
- College of Nursing, Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, Campus University Hospital, Linköping University, Building 511-001, 581 85, Linköping, Sweden
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Meka Astin
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Zehra Gok Metin
- Department of Internal Medicine Nursing, Hacettepe University, 06100, Ankara, Turkey
| | - Gisella Mancarella
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT 321, Birmingham, AL, 35294, USA
| | - Lorraine Evangelista
- Program in Nursing Science, University of California, Irvine, 299E Berk Hall, Irvine, CA, 92697-3959, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd. MDC22, Tampa, FL, 33612-4766, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
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15
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Bidwell JT, Vellone E, Lyons KS, D'Agostino F, Riegel B, Paturzo M, Hiatt SO, Alvaro R, Lee CS. Caregiver determinants of patient clinical event risk in heart failure. Eur J Cardiovasc Nurs 2017; 16:707-714. [PMID: 28513209 DOI: 10.1177/1474515117711305] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Preventing hospitalization and improving event-free survival are primary goals of heart failure (HF) treatment according to current European Society of Cardiology guidelines; however, substantial uncertainty remains in our ability to predict risk and improve outcomes. Although caregivers often assist patients to manage their HF, little is known about their influence on clinical outcomes. AIMS To quantify the influence of patient and caregiver characteristics on patient clinical event risk in HF. METHODS This was a secondary analysis of data using a sample of Italian adults with HF and their informal caregivers ( n = 183 patient-caregiver dyads). HF patients were followed over 12 months for the following clinical events: hospitalization for HF, emergency room visit for HF or all-cause mortality. Influence of baseline caregiver- and patient-level factors (patient and caregiver age; dyad relationship type; patient New York Heart Association (NYHA) Class, cognition, and comorbidities; and caregiver strain, mental health status, and contributions to HF self-care) on patient risk of death or hospitalization/emergency room use was quantified using Cox proportional hazards regression. RESULTS Over the course of follow up, 32.8% of patients died, 19.7% were hospitalized for HF and 10.4% visited the emergency room. Higher caregiver strain, better caregiver mental health status and greater caregiver contributions to HF self-care maintenance were associated with significantly better event-free survival. Worse patient functional class and greater caregiver contributions to patient self-care management were associated with significantly worse patient event-free survival. CONCLUSION Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical event risk in HF.
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Affiliation(s)
- Julie T Bidwell
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA.,a Present institution/address: Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | | | - Karen S Lyons
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Barbara Riegel
- 3 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Shirin O Hiatt
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Christopher S Lee
- 1 Oregon Health & Science University School of Nursing, Portland, OR, USA.,4 Oregon Health & Science University Knight Cardiovascular Institute, Portland, OR, USA
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16
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van Manen MA. The Ventricular Assist Device in the Life of the Child: A Phenomenological Pediatric Study. QUALITATIVE HEALTH RESEARCH 2017; 27:792-804. [PMID: 28682718 PMCID: PMC5405822 DOI: 10.1177/1049732317700853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
What is it like for a child to live with an artificial heart? The use of some medical therapies in children requires developmental considerations, is associated with psychosocial consequences, and calls for ethical sensitivities. A critical case is the ventricular assist device (VAD), a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, the device can be used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or as a destination therapy. While the mechanical-technical operation of the VAD is well understood, the clinical-technical aspects of young people living with this device are largely unexplored. Drawing on interviews of school-aged children, the aim of this phenomenological study is to explore how a VAD may structure or condition a child's meaningful experience of their world outside the hospital. The driveline of an implanted VAD is the peripheral attachment, extruding through the skin to connect the controller-power supply. The materiality of the device may be interruptive, restrictive, and disturbing to the psycho-physical being and sense of self-identity of the child as a child. And while a child equipped with a VAD is not necessarily conspicuous among other children, the child may experience the device as an exposing presence, while living with the worry of a caregiver who takes on the role not simply of parent but of watchful health professional. A phenomenological understanding of the VAD should assist parents and caregiving health professionals knowing how to deal with specific issues arising in the life of the VAD child.
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17
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Tramm R, Ilic D, Murphy K, Sheldrake J, Pellegrino V, Hodgson C. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation. J Clin Nurs 2017; 26:1657-1668. [DOI: 10.1111/jocn.13566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ralph Tramm
- Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Prahan Melbourne Vic. Australia
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine (DEPM); Monash University; Prahan Melbourne Vic. Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine (DEPM); Monash University; Prahan Melbourne Vic. Australia
| | - Jayne Sheldrake
- Department of Intensive Care and Hyperbaric Medicine; The Alfred Hospital; Prahan Melbourne Vic. Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine; The Alfred Hospital; Prahan Melbourne Vic. Australia
| | - Carol Hodgson
- Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Prahan Melbourne Vic. Australia
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18
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The Perceptions of Important Elements of Caregiving for a Left Ventricular Assist Device Patient: A Qualitative Meta-Synthesis. J Cardiovasc Nurs 2017; 31:215-25. [PMID: 25882647 DOI: 10.1097/jcn.0000000000000242] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The use of a left ventricular assist device (LVAD) is becoming increasingly common in patients with end-stage heart failure. Many LVAD programs require patients to have a caregiver before receiving a device. There are few studies exploring the experience, burden, and impacts on caregivers of patients with LVADs. OBJECTIVES The aim of this study was to synthesize the qualitative literature regarding caregiver's perceptions about caring for an adult LVAD patient. METHODS We searched MEDLINE, CINAHL, PsychInfo, and Web of Science to find English articles on the topic of LVAD caregiver's perceptions. The articles were then synthesized using a formal process of qualitative meta-synthesis. RESULTS Eight articles met criteria for inclusion. The meta-synthesis across the articles resulted in 8 themes categorized under 3 domains. Many of the articles suggested a longitudinal process of caregiving with perceptions largely dependent upon the time of interview in relation to the LVAD. The first domain of caregiving is the "early" stage, covering the life before the LVAD through the procedure. This phase is characterized by the pre-LVAD "emotional rollercoaster," the decision seen as "no option," and the thought of "leave it [the LVAD] at the hospital." The second domain is the "middle" stage, covering the time frame after discharge from the hospital. This phase is characterized by fragility of the patient, recognition of a need to adapt, and a transformed life. The final domain is "late LVAD" and describes how late in the LVAD process the LVAD indication (bridge to transplant or destination therapy) brings in to focus what is important to caregivers. CONCLUSIONS Existing literature indicates that the LVAD caregiver experience is intense as well as burdensome and entails the need to adapt to a new life. Given the burdens caregivers experience, clinicians and future research should explore strategies to support these important individuals.
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19
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Koeckert M, Vining P, Reyentovich A, Katz SD, DeAnda A, Philipson S, Balsam LB. Caregiver status and outcomes after durable left ventricular assist device implantation. Heart Lung 2017; 46:74-78. [PMID: 28057337 DOI: 10.1016/j.hrtlng.2016.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the relationship between caregiver status and outcomes after durable left ventricular assist device (LVAD) implantation. BACKGROUND The absence of a caregiver is a relative contraindication to durable LVAD support. METHODS Forty-three patients that underwent primary LVAD implantation were divided into three groups: those with caregivers that retained their roles for the duration of LVAD support (CG group), those with caregivers that resigned their roles (CG-QUIT group), and those implanted without an assigned caregiver (No-CG group). Group-specific characteristics and post-implant outcomes were compared. RESULTS In the CG-QUIT group, caregivers did not live in the same home (0.0% vs. 80.6% of CG group) and none were spouses (0.0% vs. 64.5% for CG group). Thirty-day readmission rate was highest in the CG-QUIT group (83.3% vs. 25.8% in CG group and 16.7% in No-CG group). CONCLUSIONS Caregiver relationships were more likely to be maintained for the duration of LVAD support when the caregiver was a spouse and resided in the same home as the patient. Carefully selected patients implanted without a designated caregiver had comparable outcomes to those who retained their original caregiver.
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Affiliation(s)
- Michael Koeckert
- Department of Cardiothoracic Surgery, NYU-Langone Medical Center, New York, NY, USA
| | - Patrick Vining
- Department of Cardiothoracic Surgery, NYU-Langone Medical Center, New York, NY, USA
| | - Alex Reyentovich
- Division of Cardiology, NYU-Langone Medical Center, New York, NY, USA
| | - Stuart D Katz
- Division of Cardiology, NYU-Langone Medical Center, New York, NY, USA
| | - Abe DeAnda
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Stefanie Philipson
- Department of Social Work, NYU-Langone Medical Center, New York, NY, USA
| | - Leora B Balsam
- Department of Cardiothoracic Surgery, NYU-Langone Medical Center, New York, NY, USA.
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20
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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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Neoh K, Holmes S, Woods A, Rayment C. A Matter of Time: The Case of a Patient With a Left Ventricular Assist Device. J Pain Symptom Manage 2016; 52:752-755. [PMID: 27713034 DOI: 10.1016/j.jpainsymman.2016.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/27/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Karen Neoh
- Leeds Institute of Health Sciences, Leeds, United Kingdom.
| | - Sarah Holmes
- Bradford Marie Curie Hospice, Bradford, United Kingdom
| | | | - Clare Rayment
- Bradford Marie Curie Hospice, Bradford, United Kingdom
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22
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Luo N, Rogers JG, Dodson GC, Patel CB, Galanos AN, Milano CA, O'Connor CM, Mentz RJ. Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices. Am J Cardiol 2016; 118:733-8. [PMID: 27474339 DOI: 10.1016/j.amjcard.2016.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022]
Abstract
Within the last decade, advancements in left ventricular assist device therapy have allowed patients with end-stage heart failure (HF) to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for left ventricular assist device therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists. Despite these advantages, palliative care remains underused in many advanced HF programs. Here, we describe the benefits of palliative care, barriers to use within HF, and specific applications to the integrated care of patients on mechanical circulatory support.
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Affiliation(s)
- Nancy Luo
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Joseph G Rogers
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gwen C Dodson
- Palliative Medicine Section, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Anthony N Galanos
- Palliative Medicine Section, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Carmelo A Milano
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher M O'Connor
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina; Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Robert J Mentz
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
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23
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Breathett K, Allen LA, Ambardekar AV. Patient-centered care for left ventricular assist device therapy: current challenges and future directions. Curr Opin Cardiol 2016; 31:313-20. [PMID: 26890085 PMCID: PMC4964268 DOI: 10.1097/hco.0000000000000279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Discuss the current status and obstacles that need to be overcome in the future to provide patient-centered care with left ventricular assist device (LVAD) therapy. RECENT FINDINGS LVADs offer both longer survival and improvements in quality of life for carefully selected patients with inotrope-dependent heart failure. Yet, this technology does not come without significant risk of adverse effects and burdens. Recent observational data comparing LVAD with medical therapy in ambulatory, noninotrope-dependent patients with advanced heart failure suggest that survival may be similar and changes in quality of life may depend on baseline status. As both LVAD technology and medical therapy continue to evolve, there are many unanswered questions regarding the benefits, risks, and burdens of LVAD therapies in less severe heart failure populations. SUMMARY Further research is needed to ensure the optimal delivery of LVAD therapy, including improved patient selection, implantation timing, device type, and decision support. VIDEO ABSTRACT.
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24
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Cicolini G, Cerratti F, Pelle CD, Simonetti V. The Experience of Family Caregivers of Patients With a Left Ventricular Assist Device. Prog Transplant 2016; 26:135-48. [DOI: 10.1177/1526924816640648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this review is to understand the experience of caregivers of patients with left ventricular assist device (LVAD) and to evaluate how health professionals can support them properly. Background: Left ventricular assist device can improve quality of life, enhance functional status, and prolong survival in patients with advanced heart failure. Nonetheless, LVAD can adversely influence quality of life for their family caregivers. Methods: An integrative literature review was conducted using scientific databases between January to March 2015. Results: A total of 15 studies are included in the final review. Three major themes emerged “emotional distress,” “responsibility,” and “coping strategies” that characterize family caregivers’ experiences with care of patients with LVAD. Conclusion: Health care providers should understand the pivotal role of caregivers in promoting and maintaining patients’ well-being and be able to help the caregiver to moderate the impact being overloaded. Research should be addressed to create interventions that motivate the caregivers to engage in activities that promote their health.
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Affiliation(s)
- Giancarlo Cicolini
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
- ASL02Abruzzo—Lanciano Vasto Chieti, Chieti, Italy
| | - Francesca Cerratti
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
| | - Carlo Della Pelle
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
| | - Valentina Simonetti
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
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25
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Avery LJ, Szwajcer A, Zieroth S, Temple B, Sawatzky JAV. Caregiver experiences of providing care to adult individuals living with a left ventricular assist device: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2016; 14:44-54. [PMID: 26878919 DOI: 10.11124/jbisrir-2016-2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lorraine J Avery
- 1. WRHA Cardiac Sciences Program, College of Nursing, Faculty of Health Sciences, University of Manitoba, Canada2. University of Manitoba Libraries, Canada3. WRHA Cardiac Sciences Program, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada4. College of Nursing, Faculty of Health Sciences, University of Manitoba, Canada
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26
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Smith EM, Franzwa J. Chronic outpatient management of patients with a left ventricular assist device. J Thorac Dis 2016; 7:2112-24. [PMID: 26793331 DOI: 10.3978/j.issn.2072-1439.2015.10.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The use of mechanical circulatory support (MCS) as treatment for advanced heart failure (HF) has grown exponentially over the past 15 years. The continuous flow left ventricular assist device (CF-LVAD) has become the most used form of MCS in advanced HF, especially since approval of use as destination therapy (DT) and with the lack of organ availability. Long-term survival has improved and diligent outpatient management is thus particularly critical to achieve optimal outcomes. This review will discuss outpatient management strategies for patients with HF and a left ventricular assist device (LVAD).
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Affiliation(s)
- Elisa M Smith
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA ; 2 Cardiomyopathy Treatment Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer Franzwa
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA ; 2 Cardiomyopathy Treatment Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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27
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Casida J, Wu HS, Harden J, Carie A, Chern J. Evaluation of the psychometric properties of self-efficacy and adherence scales for caregivers of patients with a left ventricular assist device. Prog Transplant 2015; 25:116-23. [PMID: 26107271 DOI: 10.7182/pit2015556] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT No published instrument has been designed to measure caregivers' self-efficacy for and adherence to the complex home-care regimen of patients with a left ventricular assist device (LVAD). OBJECTIVE To evaluate the psychometric properties of 2 newly developed instruments: the LVAD Caregiver Self-Efficacy Scale (LCSS) and the LVAD Caregiver Home Management Adherence Scale (LCAS). METHODS A multistage design was employed for this instrumentation study. Of the 125 LVAD caregivers recruited from online support groups, 98 (78.4%) provided complete data. Participants were predominantly female (80%), aged 18 to 79 years, from 4 regions of the United States. They completed the following instruments: LCSS, LCAS, General Self-Efficacy Scale (GSE), and the confidence and maintenance subscales of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI). Item analyses, factorial construct validity, convergent validity, and internal consistency reliability of the scales were evaluated. RESULTS The analysis of the LCSS (21 items) revealed a 2-factor solution, which consisted of a 17-item routine factor and a 4-item anticipatory factor. Convergent validity of the LCSS was supported by moderate correlations among LCSS, GSE, and CC-SCHFI-confidence. The analysis of LCAS (17 items) revealed a 1-factor solution. Its convergent validity was supported by moderate correlation between LCAS and CC-SCHFI-maintenance. Internal consistency reliability coefficients of the LCSS and LCAS were α = 0.93 and α = 0.96, respectively. These data suggest that the 2 instruments are adequately valid and reliable measures of self-efficacy and adherence in the context of LVAD patient care managed by home caregivers. Further research is needed to support the applicability of these instruments in other research and practice settings.
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Affiliation(s)
- Jesus Casida
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Horng-Shiuann Wu
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Janet Harden
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Austen Carie
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Joy Chern
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
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28
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Kirkpatrick JN, Kellom K, Hull SC, Henderson R, Singh J, Coyle LA, Mountis M, Shore ED, Petrucci R, Cronholm PF, Barg FK. Caregivers and Left Ventricular Assist Devices as a Destination, Not a Journey. J Card Fail 2015; 21:806-15. [DOI: 10.1016/j.cardfail.2015.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 01/14/2023]
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Kostick KM, Blumenthal-Barby JS, Wilhelms LA, Delgado ED, Bruce CR. Content Analysis of Social Media Related to Left Ventricular Assist Devices. Circ Cardiovasc Qual Outcomes 2015. [PMID: 26219889 DOI: 10.1161/circoutcomes.115.002032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Social media have the potential to offer important benefits for patient education, support, and shared decision making. Despite the proliferation of social media use during the past decade, little is known about the scope and quality of available information, or the purposes that social media sites serve for patient decisional and support needs. METHODS AND RESULTS We conducted a mixed method study, including content analysis of social media and principal components analysis analysis of data sites discussing left ventricular assist device treatment for heart failure. This study explored aspects of interactivity, user-friendliness, appeal, medium, purpose, audience, and accuracy of information. Higher levels of interactivity (eg, posting comments) seem to enhance the appeal and usability of available information but also introduce greater potential for inaccuracy and inconsistency. The current lack of oversight into the content and quality of available information constitute a challenge for the reliable use of social media as forums for information-seeking and social network-based support. CONCLUSIONS We conclude that social media outlets constitute a promising source of informational and psychosocial support for patients, caregivers, and candidates, and if used in conjunction with patient-provider dialog, can contribute to informed decision making by facilitating reflection and discussion of personal concerns, values, and informational needs.
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Affiliation(s)
- Kristin M Kostick
- From the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
| | | | - Lidija A Wilhelms
- From the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Estevan D Delgado
- From the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Courtenay R Bruce
- From the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
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30
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Abstract
The number of heart failure (HF) patients living with a left ventricular assist device (LVAD) as destination therapy is increasing. Successful long-term LVAD support includes a high degree of self-care by the patient and their caregiver, and also requires long-term support from a multidisciplinary team. All three components of self-care deserve special attention once an HF patient receives an LVAD, including activities regarding self-care maintenance (activities related both to the device and lifestyle), self-care monitoring (e.g., monitoring for complications or distress), and self-care management (e.g., handling alarms or coping with living with the device). For patients to perform optimal self-care once they are discharged, they need optimal education that focuses on knowledge and skills through a collaborative, adult learning approach.
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Affiliation(s)
- Naoko Kato
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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McIlvennan CK, Jones J, Allen LA, Lindenfeld J, Swetz KM, Nowels C, Matlock DD. Decision-making for destination therapy left ventricular assist devices: implications for caregivers. Circ Cardiovasc Qual Outcomes 2015; 8:172-8. [PMID: 25759442 DOI: 10.1161/circoutcomes.114.001276] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implanting centers often require the identification of a dedicated caregiver before destination therapy left ventricular assist device (DT LVAD) implantation; however, the caregiver experience surrounding this difficult decision is relatively unexplored. METHODS AND RESULTS From October 2012 through July 2013, we conducted semistructured, in-depth interviews with caregivers of patients considering DT LVAD. Data were analyzed using a mixed inductive and deductive approach. We interviewed 17 caregivers: 10 caregivers of patients living with DT LVAD, 6 caregivers of patients who had died with DT LVAD, and 1 caregiver of a patient who had declined DT LVAD. The themes identified, which could also be considered dialectical tensions, are broadly interpreted under 3 domains mapping to decision context, process, and outcome: (1) the stark decision context, with tension between hope and reality; (2) the challenging decision process, with tension between wanting loved ones to live and wanting to respect loved ones' wishes; and (3) the downstream decision outcome, with tension between gratitude and burden. CONCLUSIONS Decision-making surrounding DT LVAD should incorporate decision support for patients and caregivers. This should include a focus on caregiver burden and the predictable tensions that caregivers experience.
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Affiliation(s)
- Colleen K McIlvennan
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.).
| | - Jacqueline Jones
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Larry A Allen
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - JoAnn Lindenfeld
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Keith M Swetz
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Carolyn Nowels
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Daniel D Matlock
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
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Marcuccilli L, Casida JJ, Bakas T, Pagani FD. Family caregivers' inside perspectives: caring for an adult with a left ventricular assist device as a destination therapy. Prog Transplant 2015; 24:332-40. [PMID: 25488555 DOI: 10.7182/pit2014684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Understanding the experience of caring for an adult with a left-ventricular assist device as a destination therapy (LVAD-DT) remains in its infancy. OBJECTIVE/DESIGN A hermeneutic-phenomenological inquiry guided by van Manen's methods was used to explore the LVAD-DT family caregiving experience.Participants/Setting-Seven family caregivers (1 man and 6 women) 50 to 74 years old who cared for an adult with an LVAD-DT in home settings. Recruitment and data collection occurred in an outpatient mechanical circulatory support center in the Midwest. METHODS Data were collected by means of face-to-face interviews using open-ended questions and 1 follow-up interview. Interviews were audio recorded and transcribed verbatim. Thematic analysis consisted of writing, rewriting, and reflecting across participants' data, which produced themes illustrating the experience and meaning of caring for an adult with an LVAD-DT. Themes were consensually validated. Procedures for trustworthiness are described. RESULTS Five main themes were identified from participants' experiences: (1) advanced heart failure is a life-changing event, (2) self-doubt about LVAD caregiving improves over time, (3) lifestyle adjustments come with time, (4) persistent worry and stress, and (5) caregiving is not a burden-it's a part of life. These main themes were elucidated by 8 subthemes in which participants described a process of adjustment despite persistent worry and stress and eventually accepted caregiving as part of their lives. Future studies are needed to explore caregiver burden, adaptation, and the effects of caregiving outcomes, such as emotional and physical health and overall quality of life.
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33
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A comparison of the health status and psychological distress of partners of patients with a left ventricular assist device versus an implantable cardioverter defibrillator: A preliminary study. Heart Lung 2015; 44:27-32. [DOI: 10.1016/j.hrtlng.2014.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/16/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
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Mapelli D, Cavazzana A, Cavalli C, Bottio T, Tarzia V, Gerosa G, Volpe BR. Clinical psychological and neuropsychological issues with left ventricular assist devices (LVADs). Ann Cardiothorac Surg 2014; 3:480-9. [PMID: 25452908 DOI: 10.3978/j.issn.2225-319x.2014.08.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/16/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are increasingly being used to treat patients in end-stage heart failure (HF) as bridge-to-transplantation, lifetime support or destination therapy. However, the importance of this newer technique for chronic cardiac support compared to heart transplantation is still open to discussion. To date, there are few studies that extensively explore the psychological and cognitive profiles of patient with ventricular assist devices (VADs). METHODS We studied the psychological aspects, quality of life (QOL) and cognitive profiles of 19 patients with HF before VAD implantation and then at two, five and 16 months post-implantation. RESULTS Our results showed that after VAD implantation, patients did not show any psychopathological problems such as anxiety and/or depression. More interestingly, despite the constant risk of neurological events determined by the continuous-blood-flow pump (CBFP), patients' cognitive functioning did not worsen. In fact, significant enhancements were observed over time. CONCLUSIONS Psychological and cognitive deficits are common in advanced HF and often worsen over time. Appropriately designed and randomized studies are needed to demonstrate whether earlier VAD implantation is warranted to arrest cognitive decline and encourage better post-implantation adaptation.
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Affiliation(s)
- Daniela Mapelli
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Annachiara Cavazzana
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Chiara Cavalli
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Tomaso Bottio
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gino Gerosa
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Bianca Rosa Volpe
- 1 Department of General Psychology, 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Iacovetto MC, Matlock DD, McIlvennan CK, Thompson JS, Bradley W, LaRue SJ, Allen LA. Educational resources for patients considering a left ventricular assist device: a cross-sectional review of internet, print, and multimedia materials. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:905-11. [PMID: 25316772 DOI: 10.1161/circoutcomes.114.000892] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are being used with increasing frequency to treat severe heart failure. Patients seek out informational resources when considering implantation. The primary study objective was to characterize the scope and quality of available LVAD educational materials. METHODS AND RESULTS In July 2013, we performed a cross-sectional search of Internet, print, and multimedia resources available to patients considering LVAD. Written materials <10 sentences, videos <2 minutes, and materials clearly directed to healthcare professionals were excluded. Seventy-seven materials met inclusion criteria. Potential benefits of LVAD therapy were discussed in all (n=77), whereas less often mentioned were risks (n=43), lifestyle considerations (n=29), surgical details (n=26), caregiver information (n=9), and hospice or palliative care (n=2). Of the 14 materials that recognized a decision or alternate treatment option, 7 used outdated statistics, 12 scored above an eighth grade reading comprehension level, and 12 met <50% of International Patient Decision Aid Standards criteria. In the survey participants rated all but one as biased toward accepting LVAD therapy. CONCLUSIONS Although many resources exist for patients considering an LVAD, the content is suboptimal. Benefits of LVADs are often presented in the absence of risks, alternative options, and caregiver considerations. Most materials use outdated statistics, are above the reading level of average Americans, and are biased toward accepting LVAD therapy. There is no tool that would qualify as a formal decision aid.
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Affiliation(s)
- Matthew C Iacovetto
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.)
| | - Daniel D Matlock
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.)
| | - Colleen K McIlvennan
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.)
| | - Jocelyn S Thompson
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.)
| | - William Bradley
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.)
| | - Shane J LaRue
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.)
| | - Larry A Allen
- From the School of Medicine (M.C.I.), Divisions of General Internal Medicine (D.D.M.) and Cardiology (C.K.M., L.A.A.), and Colorado Health Outcomes Program (D.D.M., C.K.M., J.S.T., L.A.A.), University of Colorado School of Medicine, Aurora; Mechanical Circulatory Support Program, University of Colorado Hospital, Aurora (W.B.); and Section of Heart Failure and Cardiac Transplantation, Division of Cardiology, Department of Medicine, Washington University in St. Louis-School of Medicine, MO (S.J.L.).
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Schulz C. Existential Psychotherapy With a Person Who Lives With a Left Ventricular Assist Device and Awaits Heart Transplantation. JOURNAL OF HUMANISTIC PSYCHOLOGY 2014. [DOI: 10.1177/0022167814539192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is a case report about long-term existential psychotherapy with a person who lived with a ventricular assist device after a fulminant heart attack and who awaited heart transplantation. The therapeutic relationship lasted over 2.5 years with over 120 therapy sessions in total. The frequency of meetings was flexible. Most meetings took place in the therapy office at the hospital, with 50 minutes per session on a weekly basis. In the acute care phase and in a subsequent crisis, this frequency was increased to daily meetings in the inpatient unit. Using heuristic inquiry as a methodological approach, a co-constructed case report was generated, including verbatim transcript from recorded therapy sessions. Core existential-humanistic themes are highlighted and discussed against the background of the underlying theory.
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Affiliation(s)
- Christian Schulz
- University Dusseldorf, Dusseldorf, Germany
- Harvard Medical School, Boston, MA, USA
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Self-care and communication issues at the end of life of recipients of a left-ventricular assist device as destination therapy. Curr Opin Support Palliat Care 2013; 7:29-35. [PMID: 23314013 DOI: 10.1097/spc.0b013e32835d2d50] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of self- care and communication issues at the end of life of patients with left-ventricular assist devices (LVADs) for destination therapy, based on recent research on end-of-life communication in other diseases. RECENT FINDINGS For many patients with advanced heart failure, LVADs as destination therapy improve survival and quality of life. However, LVADs can be associated with complications, new comorbidities or worsening of previous conditions, resulting in decreased quality of life and limited prognosis, raising the need for planning palliative and end-of-life care. Open communication addressing the consequences of the LVAD implantation for daily life and the future (including advance directives) is advised in different stages of the treatment, involving a multidisciplinary team taking care of these complex patients and their caregivers. SUMMARY Healthcare professionals treating patients before and after LVAD implantation need to take an active role in end-of-life discussions and be able to communicate information regarding expected complications, quality of life and prognosis to the patients and caregivers. Research is needed addressing optimal ways and timing of communication with LVAD patients and families.
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Kitko LA, Hupcey JE, Gilchrist JH, Boehmer JP. Caring for a spouse with end-stage heart failure through implantation of a left ventricular assist device as destination therapy. Heart Lung 2013; 42:195-201. [PMID: 23499234 DOI: 10.1016/j.hrtlng.2012.10.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/10/2012] [Accepted: 10/13/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This qualitative study describes the experiences of spousal caregivers of a patient with end-stage heart failure (HF) from pre-LVAD to post-LVAD-DT implantation. BACKGROUND LVAD-DTs are implanted as permanent devices for end-stage HF patients with the goal of improving the length and quality of life. LVADs create new demands for both patients and caregivers. METHODS In-depth, semi-structured interviews of 10 spousal caregivers were thematically analyzed. RESULTS Throughout the process of caregiving, pre-implant through post-implant, all caregivers discussed their ability to adapt within the role as a caregiver. Adaptation as a caregiver occurred through three distinct time frames following the progression of the patient's HF and subsequent LVAD implantation: caring for a spouse with HF, decision for LVAD implantation made, and caring for a spouse with the LVAD-DT. CONCLUSIONS Caregivers were able to adapt and develop effective strategies to incorporate the demands of caring for a spouse with an LVAD-DT, but the role remained challenging. The findings underscore the need for continued research that may be translated into effective interventions to support patient and caregivers as they live through this end-of-life trajectory.
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Affiliation(s)
- Lisa A Kitko
- The Pennsylvania State University, School of Nursing, 201 Health and Human Development East, University Park, PA 16802, USA.
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Ben Gal T, Jaarsma T. Patients with a Left Ventricular Assist Device: the new chronic patient in cardiology. Eur J Cardiovasc Nurs 2012; 11:378-9. [DOI: 10.1177/1474515112441145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
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Vitale CA, Chandekar R, Rodgers PE, Pagani FD, Malani PN. A Call for Guidance in the Use of Left Ventricular Assist Devices in Older Adults. J Am Geriatr Soc 2012; 60:145-50. [DOI: 10.1111/j.1532-5415.2011.03740.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Rashmi Chandekar
- Division Infectious Diseases; Department of Internal Medicine; University of Michigan Health System; Ann Arbor; Michigan
| | - Phillip E. Rodgers
- Division of General Internal Medicine; Department of Internal Medicine; Virginia Commonwealth University Health System; Richmond; Virginia
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Abstract
BACKGROUND Every year in Sweden, between five and ten patients receive a mechanical heart pump due to grave heart failure. One such pump is the left ventricle assist device (LVAD). At home they need much support from their family. AIM To investigate the close relatives' experience of their role in relation to patients with an LVAD. METHODS An exploratory study using unstructured interviews with six close relatives of patients with an LVAD. The interviews consisted of one open question: 'What is it like to be the close relative of a patient with an LVAD?' The interviews were analysed using thematic content analysis. RESULTS The time before LVAD surgery was described as a time of emotional ups and downs, and compared to 'being on an emotional rollercoaster ride'. The nearest relatives were in shock, felt anxiety and uncertainty, and wished to be near the patient. The time after surgery was described as a period in which they had to 'cope with the new situation.' During this period, the staff was experienced as a resource and the relatives described feelings of gratitude, willpower, and acceptance. The stay at home with a person with an LVAD was described as a 'new orientation phase' with limited freedom and the need for respite care. The interviewees expressed the need for support, especially once the patient was at home. CONCLUSION It is important to also offer long-term professional support to the nearest relatives of patients with an LVAD.
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Informal caregivers' experiences of caring for patients with chronic heart failure: systematic review and metasynthesis of qualitative studies. J Cardiovasc Nurs 2012; 26:386-94. [PMID: 21263337 DOI: 10.1097/jcn.0b013e3182076a69] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing evidence suggests that family support for patients with chronic heart failure (CHF) contributes greatly to the disease management of CHF. In addition, the quality of the CHF patient's close personal relationships can influence CHF outcomes. However, caregivers cannot provide care alone and need guidance, support, and skills to manage care that is often complex. In this article, we provide a review of studies that have explicitly investigated these issues of informal caregivers to CHF patients. OBJECTIVE The objective of this study was to explore informal caregivers' views and experiences of caring for patients with CHF. METHODS This is a systematic review and synthesis of qualitative studies describing informal caregivers' experiences in home-based care. Data sources were published literature written in English from electronic databases: PubMed, CINAHL (1982-2009), PsycINFO (1967-2009), EMBASE (1980-2009), and the Cochrane Library Database. Ten primary studies met the inclusion criteria. RESULTS A number of themes emerged. Five key themes were identified from synthesis of the studies: sharing of caring, suffering from anxiety, being isolated, enjoying a good relationship, and searching for support. CONCLUSIONS Caring for persons with CHF can affect the well-being of their informal caregivers, which may ultimately have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF.
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Upstream Palliative Care for the Patient With a Left Ventricular Assist Device as Destination Therapy. Dimens Crit Care Nurs 2012; 31:18-24. [DOI: 10.1097/dcc.0b013e31823a537c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Marcuccilli L, Casida J. From insiders' perspectives: adjusting to caregiving for patients with left ventricular assist devices. Prog Transplant 2011. [DOI: 10.7182/prtr.21.2.dq53164u1464u683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marcuccilli L, Casida JM. From Insiders' Perspectives: Adjusting to Caregiving for Patients with Left Ventricular Assist Devices. Prog Transplant 2011; 21:137-43. [DOI: 10.1177/152692481102100209] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Caregivers for patients with a long-term implantable left ventricular assist device have a very important role in helping patients maintain their health and well-being and attain an improved quality of life. Although the caregiving tasks, burdens, and challenges of family caregivers have been described in the literature, we know little about how caregivers adjust to or accommodate the new role in their lives. Objective To explore and describe the lifestyle adjustments of caregivers for adults living with a left ventricular assist device as a bridge to heart transplant or destination therapy. Design A hermeneutic phenomenology was used as a guide for interviews and analysis of the data. Participants A purposive convenience sample of 5 women, aged 39 to 71 years, who had served as caregivers of a left ventricular assist device patient for at least 3 months. Setting Recruitment and data collection (interviews) were conducted in an outpatient clinic for the mechanical circulatory support program of a large academic medical center in the Midwest. Results Three main themes (caregiving: a “24/7” responsibility, coping strategies, and satisfaction) and 13 subthemes emerged from the data. Conclusions Lifestyle adjustments with caregiving may become easier over time, and with effective use of coping strategies, caregivers accept their new caregiving role as part of life.
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