What Really Matters? Understanding Quality of Life Determinants Impacting Ventricular Assist Device Stakeholders

It's not only the pump: Assessment of human factors of wearable components and user experience of patients with left ventricular assist devices

BACKGROUND

Despite design improvements in left ventricular assist devices (LVADs) over the past decade, limitations of external, wearable VAD components affect patient quality of life and safety. The aim of this study was to describe both user experience and human factor issues of 2 contemporary LVADs.

METHODS

This single-center, cross-sectional study included LVAD outpatients who were at least 3 months after implantation. Before developing the 16-item survey, a systematic literature review and 2-round Delphi method involving 9 VAD clinicians were used to select items in 6 domains: power supply, emergency situations, wearability, mobility, and freedom to travel, user modifications, lifestyle, and home adaptations.

RESULTS

Fifty-eight patients (61.6 ± 11.6 years, 13.8% female, HeartMate 3 (HM3)/HVAD: n = 39/19) completed the one-time survey after median of 853 days on device: 10.3% reported problems changing power supply, 12.7% unintentional driveline disconnection (HM3: 5.6% vs HVAD: 26.3%, p = 0.041). Against the recommendation 74.1% sleep with battery-support (HM3: 88.9% vs HVAD: 44.4%, p = 0.001). About 65.3% criticized the carry bag weight/size (HM3: 71.4% vs HVAD: 50.0%, p = 0.035), thus 24.1% wear an own carrying-system, 42.1% modified their wearables, 38.9% their clothing, and 65.3% their home to cope with life on LVAD support. Mobility is reduced due to limited wearability: 18.9% went abroad (only 3.7% by plane) and 40.0% use less public transport than before implantation (the older the less: r = -0.37, p = 0.013).

CONCLUSIONS

HVAD and HM3 wearables still show a variety of human factors issues and potential for improved user experience. User-centered design and incorporation of patient feedback may increase user satisfaction, and patient safety.

Depression, anxiety, stress levels, and coping styles of caregivers of patients with left ventricular assist device

PURPOSE

To determine the depression, anxiety, stress (DAS) levels, and coping styles of caregivers of patients with left ventricular assist device (LVAD).

DESIGN AND METHODS

The sample of the study consisted of 74 caregivers of patients with LVAD. Data were collected using Individual Data Form, DASS 21, and Coping Styles Scale.

FINDINGS

Depression was found in 67.6%, anxiety in 45.9%, and stress in 50% of the caregivers of patients with LVAD. A significant relationship was found between the sociodemographic characteristics of caregivers, some variables related to the patient and the care process, and coping styles with stress, and DAS levels of caregivers.

PRACTICE IMPLICATIONS

Considering the variables that may affect the DAS levels of the LVAD caregivers will improve the expected results from the LVAD.

Patient names for mechanical circulatory support devices: Developing emotional insights

BACKGROUND

Patients with mechanical circulatory support devices regularly experience positive and negative emotions which are reinforced through interactions with their device. We explored emotional relationships between patients and their MCS devices through the names they assign to those devices.

OBJECTIVES

We sought to characterise device naming and suggest future developments which might capitalise on the naming phenomenon to improve patient wellbeing.

METHODS

Qualitative online ethnography extracted comments on device names and emotions from a social media group. Thematic analysis grouped the comments according to their explicit or implied emotions, and their potential consequences for designing future MCS treatment.

RESULTS

Thematic analysis identified 28 codes to characterise the names, from which we inferred 4 main themes for proposed emotional relationships. They centred on humour, coping, improving acceptance for family and friends, and reclaiming agency.

CONCLUSION

We suggest that by deliberately considering these factors in future research and development, clinicians and device manufacturers have scope to improve patient wellbeing.

A systematic review of psychosocial design considerations for the next generation of mechanical circulatory support

BACKGROUND

Biomedical engineers are developing new mechanical circulatory support pumps. Clinicians are generating and analysing new evidence for their prescription and management. Industrial designers are generating usable solutions for wearable components and controllers. However, psychosocial considerations may be falling between the cracks of the three disciplines because of their multi-faceted nature.

OBJECTIVES

This article seeks to identify psychosocial needs raised in previous work, re-frame them as needs for future products and services, and discuss routes to solutions.

METHODS

SLR extracted 225 statements on psychosocial considerations from 42 included articles. 23 codes were inductively generated and applied to relevant datapoints. Codes were consolidated under 4 main themes and re-framed as solvable problems.

RESULTS

Identified themes: expanded remote care, improved multidisciplinary management tools, creating easier interactions; and extending patient engagement.

CONCLUSIONS

Design-driven methods have been used to solve analogous problems in other contexts and can address the identified psychosocial problems if implemented fully.