1
|
Asase M, Watanabe T, Takegami M, Nishimura K, Nin K, Fukushima N. Impact of Different Therapeutic Strategies With Left Ventricular Assist Devices on Health-Related Quality of Life During Prolonged Device-Based Support. Circ Rep 2023; 5:289-297. [PMID: 37431516 PMCID: PMC10329900 DOI: 10.1253/circrep.cr-22-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/19/2023] [Accepted: 04/16/2023] [Indexed: 07/12/2023] Open
Abstract
Background: Left ventricular assist device (LVAD) implantation improves survival and health-related quality of life (HRQoL) of patients with heart failure. However, the impact of LVADs or different LVAD-based therapeutic strategies on long-term HRQoL has not been investigated. We evaluated the long-term HRQoL of Japanese patients who were treated with different LVAD-based therapeutic strategies. Methods and Results: Patients whose data were recorded in the Japanese Registry for Mechanical Assisted Circulatory Support between January 2010 and December 2018 were divided into 3 groups: primary implantable LVAD (G-iLVAD; n=483), primary paracorporeal LVAD (n=33), and bridge-to-bridge from paracorporeal to implantable LVAD (n=65). HRQoL was evaluated using the EuroQoL 5-dimension 3-level (EQ-5D-3L) before and 3 and 12 months after LVAD implantation; the mean EQ-5D-3L visual analog scale (VAS) score in the G-iLVAD group at these time points was 47.4, 71.1, and 72.9, respectively (where scores of 0 and 100 indicate worst and best imaginable health state, respectively). Changes in the least squares means of the VAS scores at 3 and 12 months after implantation differed significantly among the 3 groups. Social function, disability, and physical and mental problems were significantly lower in the G-iLVAD than other groups. Conclusions: HRQoL improved significantly at 3 and 12 months after LVAD implantation in all groups. Physical function showed a stronger improvement than did social function, disability, and mental function.
Collapse
Affiliation(s)
- Mariko Asase
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University Kyoto Japan
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Suita Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Suita Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center Suita Japan
- Faculty of Nursing, Graduate School of Nursing, Senri Kinran University Suita Japan
| |
Collapse
|
2
|
Knoepke CE, Siry-Bove B, Mayton C, Latimer A, Hart J, Allen LA, Daugherty SL, McIlvennan CK, Matlock DD, Khazanie P. Variation in Left Ventricular Assist Device Postdischarge Caregiver Requirements: Results From a Mixed-Methods Study With Equity Implications. Circ Heart Fail 2022; 15:e009583. [PMID: 35862012 PMCID: PMC9388601 DOI: 10.1161/circheartfailure.122.009583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) evaluation includes a psychosocial assessment, conducted by social workers (SWs) on the advanced heart failure multidisciplinary team. Postdischarge caregiving plans are central to psychosocial evaluation. Caregiving's relationship with LVAD outcomes is mixed, and testing patients' social resources may disadvantage those from historically undertreated groups. We describe variation in policies defining adequate caregiving plans post-LVAD implant and possible impacts on patients from marginalized groups. METHODS This was a 2-phase sequential mixed-methods study: (1) phase 1, survey of US-based LVAD SWs, describing assessment structure and policies guiding candidacy outcomes; and (2) phase 2, individual interviews with SWs to further describe how caregiving plan adequacy impacts LVAD candidacy. RESULTS Sixty-seven SWs returned surveys (rr=47%) from unique programs. Caregiving plan inadequacy (n=30) was the most common psychosocial dealbreaker. When asked what duration of caregiving is required, 23% indicated ≥3 months, 27% 4 to 12 weeks, and 30% <4 weeks. Two reported no duration requirement, 6 stated an indefinite 24/7 commitment was necessary. Across 22 interviews, SWs mirrored that caregiving plans were the most common psychosocial contraindication. How caregiving is operationalized varied. Participants voiced a tension between extended caregiving improving outcomes and the sense that some people of color, women, or low socioeconomic status patients struggle to meet stringent requirements. CONCLUSIONS Policies regarding adequate duration of 24/7 caregiving vary, but inadequate caregiving plans are the most common psychosocial contraindication. Participants worry about patients' ability to meet restrictive requirements, particularly from historically undertreated groups. This highlights a need to operationalize quality caregiving, standardize assessment, and support medically appropriate patients with strained social resources.
Collapse
Affiliation(s)
- Christopher E Knoepke
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Bonnie Siry-Bove
- Department of Emergency Medicine (B.S.-B.), University of Colorado Anschutz Medical Campus, Aurora
| | - Caitlin Mayton
- School of Social Work, Virginia Commonwealth University, Richmond (C.M.)
| | - Abigail Latimer
- College of Nursing, University of Kentucky, Lexington (A.L.)
| | - Jan Hart
- Ascension St. Vincent Medical Center, Indianapolis, IN (J.H.)
| | - Larry A Allen
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Stacie L Daugherty
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora.,Institute for Health Research, Kaiser Permanente Colorado, Aurora (S.L.D.)
| | - Colleen K McIlvennan
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora
| | - Daniel D Matlock
- Division of Geriatric Medicine (D.D.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Prateeti Khazanie
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora
| |
Collapse
|
3
|
Levelink M, Reinhold AK, Dewald O, Brütt AL. Psychological burden and coping in destination therapy patients with a left ventricular assist device: a qualitative content analysis. Artif Organs 2021; 46:1165-1180. [PMID: 34932234 DOI: 10.1111/aor.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to an increasing prevalence of heart failure and persistent shortage of donor hearts, the number of left ventricular assist device (LVAD) implantations is growing. As more patients live with LVADs for prolonged periods of time, psychosocial outcomes are becoming more relevant. This particularly applies to destination therapy (DT) patients, who live with the LVAD for the rest of their lives. METHODS We used a cross-sectional qualitative design to explore psychological burden, coping strategies and resources from the perspective of DT patients. Data was collected via semi-structured in-depth interviews with 18 patients who lived with the LVAD for 3 months to over 10 years. These were analyzed using an inductive content analysis. Due to the COVID-19 pandemic, changes to the recruitment strategy and data collection strategies of the original study protocol were applied. Patients and clinicians were involved throughout the research process to ensure validity of the results and implications. RESULTS We synthesized 10 psychosocial, health, and treatment-related burdens, identified 15 problem- and emotion-focused coping strategies and 5 personal and environmental resources patients used to cope with the burden. CONCLUSIONS The findings provide deeper insights into the complex and specific situation of LVAD patients to better address the patient situation in health care and promote positive psychosocial outcomes. So far, health care practice and quality vary significantly between clinics due to individual treatment protocols. Our results highlight the need to improve medical and psychosocial care. Overarching care concepts may be developed based on the implications.
Collapse
Affiliation(s)
- Michael Levelink
- Carl von Ossietzky Universität Oldenburg, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Fakultät VI, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany
| | - Anna Katharina Reinhold
- Carl von Ossietzky Universität Oldenburg, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Fakultät VI, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany
| | - Oliver Dewald
- Klinikum Oldenburg AöR, Universitätsklinik für Herzchirurgie, Oldenburg, Germany
| | - Anna Levke Brütt
- Carl von Ossietzky Universität Oldenburg, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Fakultät VI, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany
| |
Collapse
|