1
|
Willy K, Ellermann C, Reinke F, Rath B, Wolfes J, Eckardt L, Doldi F, Wegner FK, Köbe J, Morina N. The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9080257. [PMID: 36005421 PMCID: PMC9409697 DOI: 10.3390/jcdd9080257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022] Open
Abstract
The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.
Collapse
Affiliation(s)
- Kevin Willy
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
- Department of Psychology, University of Münster, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-251-83-44949; Fax: +49-251-83-52980
| | - Christian Ellermann
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix K. Wegner
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, 48149 Münster, Germany
| | - Nexhmedin Morina
- Department of Psychology, University of Münster, 48149 Münster, Germany
| |
Collapse
|
2
|
OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
|
3
|
Meehan K, Schroeder SE, Creighton S, Labuhn C. Psychological Journey of a Patient With a Ventricular Assist Device: A VAD Coordinator's Perspective. AACN Adv Crit Care 2021; 32:443-451. [PMID: 34879126 DOI: 10.4037/aacnacc2021744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A thorough psychosocial assessment is needed during the evaluation of candidacy for ventricular assist device placement to identify potential barriers that would limit success with the device. Ventricular assist device coordinators are generally involved in the psychosocial assessment of the patient, allowing them to provide a more holistic approach to ventricular assist device candidacy during discussions at multidisciplinary meetings. There is a gap in the literature describing the psychological journey of patients after ventricular assist device implantation and the challenges ventricular assist device coordinators face when caring for this complex population. OBJECTIVE The psychological journey of 3 patients with a ventricular assist device was explored to determine if common themes exist and to describe the experiences faced by the ventricular assist device coordinators with each patient. METHODS Three patient case scenarios are described, as are the interactions with the patients' ventricular assist device coordinator team members. RESULTS All 3 case scenarios demonstrate similarities of younger ages, the need of family and social support, and ventricular assist device coordinators who went beyond the call of duty to assist in the successful heart transplantation for 2 cases and the successful decommission of the ventricular assist device in another case. CONCLUSION The psychosocial needs of patients with a ventricular assist device and ventricular assist device coordinators require ongoing assessment because of the many physical and emotional challenges that arise during the time a patient has an implanted ventricular assist device.
Collapse
Affiliation(s)
- Karen Meehan
- Karen Meehan is Advanced Practice Nurse, MCS Coordinator, Department of Cardiac Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, Suite E500, MC5040, Chicago, IL 60637
| | - Sarah E Schroeder
- Sarah E. Schroeder is MCS Nurse Practitioner and Program Manager, Division of MCS Therapy, Bryant Heart, Lincoln, Nebraska
| | - Shana Creighton
- Shana Creighton is Advanced Practice Nurse, MCS Coordinator, Department of Cardiac Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Colleen Labuhn
- Colleen Labuhn is Executive Director of the Heart and Vascular Institute, Assistant Director of Advanced Practice Services, and Advanced Practice Nurse, MCS Coordinator, Department of Cardiac Surgery, University of Chicago Medical Center, Chicago, Illinois
| |
Collapse
|
4
|
Abstract
Left ventricular assist devices (LVADs) are indicated in inotrope-dependent heart failure (HF) patients with pure or predominant LV dysfunction. Survival benefit is less clear in ambulatory, advanced HF. Timing is crucial: early, unnecessary exposure to the risks of surgery, and device-related complications (infections, stroke, and bleeding) should be weighed against the probability of dying or developing irreversible right ventricular and/or end-organ dysfunction while deferring implant. The interplay between LVAD and heart transplantation depends largely on donor availability and allocation rules. Postoperatively, quality of life depends on patients' expectations and is influenced by complications. Patients' preferences, prognosis, and alternative options-including palliation-should be openly discussed and reviewed before and after the operation.
Collapse
Affiliation(s)
- Maria Frigerio
- 2nd Section of Cardiology, Heart Failure and Transplant Unit, DeGasperis CardioCenter, Niguarda Great Metropolitan Hospital, Milan, Italy.
| |
Collapse
|
5
|
Rossi Ferrario S, Panzeri A, Pistono M. Psychological difficulties of LVAD patients and caregivers: A follow up over 1 year from discharge. Artif Organs 2021; 46:479-490. [PMID: 34519060 PMCID: PMC9292387 DOI: 10.1111/aor.14071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
Background After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home. Objective This study aimed at evaluating the post‐discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health. Methods In this observational follow‐up study, LVAD dyads discharged home from 1 year to 6 years were re‐contacted by phone and received by mail an envelope with self‐report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed. Results Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective–sexual relationship. Caregivers often reported impairment in social life and self‐care. Discussions Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.
Collapse
Affiliation(s)
- Silvia Rossi Ferrario
- Unit of Psychology-Neuropsychology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
| | - Anna Panzeri
- Department of General Psychology, University of Padua, Padova, Italy
| | - Massimo Pistono
- Unit of Cardiology, IRCCS ICS Maugeri, Institute of Veruno, Veruno, Italy
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Mariani S, Napp LC, Schmitto JD. Mens sana in corpore sano: Challenges beyond LVAD implantation. Artif Organs 2020; 44:1310-1311. [DOI: 10.1111/aor.13774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
| | - Lars Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Jan D. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
| |
Collapse
|
8
|
Okam NA, Ahmad W, Rana D, Torrilus C, Jahan N, Sedrakyan S. Psychological Spectrum Experienced by Heart Failure Patients After Left Ventricular Assist Device Implantation. Cureus 2020; 12:e9671. [PMID: 32923266 PMCID: PMC7485994 DOI: 10.7759/cureus.9671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Depression and anxiety disorders are prevalent in patients with heart failure. They are associated with adverse effects such as rapid disease progression, poor medication compliance, low quality of life and increased mortality rate. The current literature review aims to provide an overview of the overall rate of depression in patients who receive left ventricular assist device (LVAD) implantation and identify the psychological phases that these individuals experienced peri- and post-LVAD implantation. A PubMed search using regular and Medical Subject Headings (MeSH) keywords identified 239 articles. After applying inclusion/exclusion criteria, removal of duplicate studies, and careful review of articles, 40 studies provided relevant information on our primary end-point. These 40 studies selected include 13 paid articles with abstracts and 27 free full-text articles comprising eight prospective cohort studies, five retrospective cohort studies, six cross-sectional studies, one qualitative study, one randomized clinical trial, one systematic review, four literature reviews, and one practice guide. Our review shows that patients experienced different psychological phases after LVAD implantation. However, as the time from implantation progressed, these patients showed a significant improvement in depression, anxiety, and health-related quality of life.
Collapse
Affiliation(s)
- Nkechi A Okam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Wiqas Ahmad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dibyata Rana
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chenet Torrilus
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Surik Sedrakyan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
9
|
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: 8] [Impact Index Per Article: 2.0] [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.
Collapse
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
| |
Collapse
|