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Richter F, Spielmann H, Semmig-Koenze S, Spitz-Köberich C, Knosalla C, Kugler C, Tigges-Limmer K, Albert W. Disturbance in bodily experience following ventricular assist device implantation. J Heart Lung Transplant 2024; 43:1241-1248. [PMID: 37923150 DOI: 10.1016/j.healun.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/23/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Disturbance in bodily experience (BE) is a potential adverse consequence of ventricular assist device (VAD) implantation. The concept BE encompasses all cognitive and affective processes related to the subjective experience of one's own body. METHODS A cross-sectional, multicenter study was performed, involving 365 VAD patients (85% male; time postimplant: 3-36 months). Patients completed a BE questionnaire (BE-S, 5-point Likert scale), and the disturbance in BE was analyzed based on sex, time since implantation (in the first, second, or third years postimplant), and patient acuity (elective vs emergent implantation). Subsidiary, patients' gratitude was surveyed. RESULTS Disturbance in BE was not particularly pronounced (mean = 2.69, standard deviation = 1.17). Eighty-five percent of patients expressed high levels of gratitude. Disturbance in BE decreased (p = 0.04), while gratitude increased (p = 0.02) with time since implantation. Female patients showed more disturbance in BE (p = 0.01) and less gratitude (p = 0.01) compared to male patients. Among patients who underwent emergency implantation, the decrease in disturbance occurred predominantly in the third year, exceeding the level observed in elective implanted patients (p = 0.03). CONCLUSIONS Disturbance in BE following VAD implantation does generally not reach excessive levels and tends to decrease over time. Our data indicate more disturbance and less gratitude in female patients. In emergently implanted patients, disturbance in BE is prolonged. Screening for disturbance in BE is recommended during follow-up, especially for these at-risk groups, to ensure early and focused psychological support.
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Affiliation(s)
- Fabian Richter
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hannah Spielmann
- University of Freiburg, Faculty of Medicine, Institute of Nursing Science, Freiburg, Germany
| | | | - Christine Spitz-Köberich
- Medical Center - University of Freiburg, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Christoph Knosalla
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Christiane Kugler
- University of Freiburg, Faculty of Medicine, Institute of Nursing Science, Freiburg, Germany
| | - Katharina Tigges-Limmer
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Wolfgang Albert
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Kugler C, Spielmann H, Albert W, Lauenroth V, Spitz-Koeberich C, Semmig-Koenze S, Staus P, Tigges-Limmer K. Professional Employment in Patients on Ventricular Assist Device Support-A National Multicenter Survey Study. ASAIO J 2024; 70:348-355. [PMID: 38170263 PMCID: PMC11057483 DOI: 10.1097/mat.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
This study aimed to assess patients of working age returning to professional employment as a surrogate marker for functional recovery and psychosocial reintegration after ventricular assist device (VAD) implantation. A national, multicenter study considered professional employment and its relationship to sociodemographic, psychosocial, and clinical adverse outcomes in outpatients on VAD support. Patient-reported outcome measures were administered. The survey had a 72.7% response rate. Mean age of 375 subjects was 58 ± 11 years, 53 (14%) were female. Thirty-five patients (15.15%; 95% confidence interval [CI] = 10.9-20.6) were employed, and the majority of them (n = 29, 82.9%) were bridged to transplantation. A regression model after variable selection revealed younger age (odds ratio [OR] = 0.95; 95% CI = 0.91-0.98; p < 0.005), and higher education (OR = 3.05; 95% CI = 1.72-5.41; p < 0.001) associated with professional employment. Employed patients reported higher health-related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire [KCCQ] overall sum-score, OR = 1.04; 95% CI = 0.92-1.07; p < 0.007), the OR for those employed was 2.18 (95% CI = 0.89-5.41; p < 0.08) indicating no significant relation for employment and a history of adverse events. In this sample, professional employment was rather small; the likelihood of adverse events was not significantly different between groups. Those employed perceived better overall HRQoL, which may encourage clinicians to support professional employment for selected patients on VAD support.
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Affiliation(s)
- Christiane Kugler
- From the Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Hannah Spielmann
- From the Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | | | - Volker Lauenroth
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | | | - Paulina Staus
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Katharina Tigges-Limmer
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
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Yoo HJ, Shin S. Mobile Health Intervention Contents and Their Effects on the Healthcare of Patients with Left Ventricular Assist Devices: An Integrative Review. Comput Inform Nurs 2024; 42:193-198. [PMID: 37607571 DOI: 10.1097/cin.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Self-care in daily life is important for patients with a left ventricular assist device. Mobile health interventions that use an application, the cloud, or telemonitoring enable active health management. This study reviewed the literature on the contents of mobile health interventions for patients with left ventricular assist devices and their effects. We searched four electronic databases (CINAHL, Cochrane Library, EMBASE, and MEDLINE) and reference lists in May 2022. The search terms consisted of "heart-assist devices" and "residence characteristics," combined with "mobile applications," "telemonitoring," "medical informatics applications," "cell*," "app*," "smartphone," and "cloud." In total, seven studies were included in the review. Mobile health interventions included (1) self-management contents and (2) interactions between patient and healthcare providers. The mobile health device and patient's health management were evaluated as a measure of the effect. This review provides a unique understanding for leveraging mobile health interventions as an effective approach to improve healthcare among patients with left ventricular assist devices. Future mobile health intervention strategies targeting these patients should fully consider the patient's perspective. Furthermore, they should be designed and applied to help with long-term health management, accompanied by an evaluation of their effectiveness on self-care improvement.
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Affiliation(s)
- Hye Jin Yoo
- Author Affiliations: College of Nursing, Dankook University, Cheonan (Dr Yoo); and Samsung Medical Center, Seoul, South Korea (Ms Shin)
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Spielmann H, Albert W, Semmig-Könze S, Lauenroth V, Spitz-Köberich C, Staus P, Tigges-Limmer K, Kugler C. High level of psychosocial adjustment in patients on ongoing ventricular assist device support in the years one to three after VAD implantation-A national multi-center Study. Heart Lung 2024; 63:92-97. [PMID: 37837720 DOI: 10.1016/j.hrtlng.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Advanced heart failure therapies such as durable ventricular assist device (VAD) support require psychosocial adjustment for those affected. Since VAD implantation has become an established treatment strategy, a focus on psychosocial factors is needed. OBJECTIVES To investigate the construct of psychosocial adjustment and to further understand the role of social support. METHODS In a nation-wide, multi-center, cross-sectional study, we recruited 393 participants with ongoing VAD support (3mts-3yrs on device; clinicaltrials.gov ID: NCT04234230). Patient demographics, psychosocial adjustment (perceived social support, anxiety, depression, and quality of life), and major adverse events (thromboembolic events, bleeding, driveline infections) were assessed. RESULTS Overall, 85.8 % of the sample were male; mean age was 58.3 years (range 18-85). The majority of the sample (89.3 %) reported normal to high perceived social support. Participants expressed symptoms of anxiety within the normal range (M=6.0±3.9), mildly elevated depressive symptoms (HADS: M=7.6±2.9; PHQ-9: M=6.2±4.7), and good quality of life (KCCQ: M=65.3±17.9). Higher perceived social support was associated with lower levels of anxiety and depression, and higher levels of quality of life within our sample (all p<0.001). Driveline infection was the most prevalent adverse event (0.304 infections per person-years [32.6 % of patients]). Binary logistic regression models did not identify significant associations for the occurrence of adverse events and variables of psychosocial adjustment. CONCLUSION Our sample perceived high levels of psychosocial adjustment. High perceived social support was associated with better outcomes in levels of anxiety, depression, and quality of life, demonstrating potential for the future development and evaluation of targeted multi-professional social support interventions including peer- and caregiver support.
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Affiliation(s)
- Hannah Spielmann
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg 79110, Germany
| | | | | | - Volker Lauenroth
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christine Spitz-Köberich
- Department Pediatric Cardiology, Medical Center - University of Freiburg, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Paulina Staus
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Germany
| | - Katharina Tigges-Limmer
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christiane Kugler
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg 79110, Germany.
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Spielmann H, Tigges-Limmer K, Albert W, Spitz-Köberich C, Semmig-Könze S, Staus P, Herrmann-Lingen C, Sandau KE, Okeson B, Geyer S, Kugler C. Health-Related Quality of Life in Patients With Ventricular Assist Device: Psychometric Evaluation of the German Version of the Quality of Life With a Ventricular Assist Device Questionnaire. J Cardiovasc Nurs 2023:00005082-990000000-00153. [PMID: 37991265 DOI: 10.1097/jcn.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Ventricular assist device (VAD) implantation has become an alternative treatment for patients with end-stage heart failure. In Germany, valid and reliable instruments to assess health-related quality of life in patients with VAD are lacking. OBJECTIVE The aim of this study was to present the psychometric validation of the German version of the Quality of Life with a Ventricular Assist Device questionnaire. METHODS In a multicenter, cross-sectional study, 393 participants (mean age, 58.3 years; 85.8% male, 60.3% bridge to transplant, and 72.8% living with VAD for ≤2 years) completed the German Quality of Life with a Ventricular Assist Device questionnaire of physical, emotional, social, cognitive, and meaning/spiritual domains. Item and confirmatory factor analyses were conducted to test item difficulty and discrimination and the underlying structure, respectively. To examine internal consistency, Cronbach α was assessed. Convergent construct validity was tested using the Kansas City Cardiomyopathy Questionnaire and the Patient Health Questionnaire-9. Readability was examined using Flesch Reading Ease index and Vienna Factual Text Formula. RESULTS The Quality of Life with a Ventricular Assist Device showed reasonable item difficulty (Ptotal = .67) and mostly moderate to high discriminatory power (rit > 0.30). In confirmatory factor analysis, root-mean-square error of approximation (0.07) was acceptable for model fit, but no other indices. Acceptable internal consistency was found (α ≥ 0.79), with the exception of the cognitive domain (α = 0.58). The overall questionnaire and single domains demonstrated convergent validity (r ≥ 0.45, P < .001). The questionnaire showed adequate readability (Flesch Reading Ease, 64.11; Vienna Factual Text Formula, 6.91). CONCLUSION Findings indicate a promising standardized clinical instrument to assess health-related quality of life in patients with VAD.
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Treß F, Spitz-Koeberich C, Rebafka A, Schibilsky D, Kugler C. Balancing normalcy and safety: health-related needs in patients with a ventricular assist device within their home environment. Eur J Cardiovasc Nurs 2021; 21:446-452. [PMID: 34871390 DOI: 10.1093/eurjcn/zvab113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/20/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022]
Abstract
AIMS Ventricular assist device (VAD) implantation has become a well-established treatment strategy for patients suffering from advanced heart failure. Ventricular assist device treatment attempts to ameliorate the symptom burden but may create new challenges in patients' lives. Lacking are insights into perceived challenges and health-related needs of patients with VAD within their home environment. Our study aimed to explore the perceived health-related needs of patients living with a VAD in their home environment. METHODS AND RESULTS We used a qualitative approach based on a hermeneutic, directed content analysis design. Telephone-based interviews were conducted with 10 patients with VAD from a single cardiology centre in Germany. Data collection and analyses were carried out using content-structuring content analyses. Normalcy and safety were identified as overarching themes: participants expressed a need to balance daily activities between striving for normalcy and maintaining safety. Underlying necessities reflecting this balance were categorized as functional, social, and mental health-related needs. Learning by doing, social-, and peer support were described as relevant requisites. Fulfilling these health-related needs could aid patients living with VAD in achieving the sense of normalcy and safety they seek. CONCLUSION Balancing health-related needs with striving for normalcy and safety, emerged as a new core concept for patients with VAD. Thus, being cognizant of this balance when caring for these patients, could facilitate coping after VAD implantation through increasing acceptance of limitations to daily functions by enhancing individual safety. A supportive social environment, including peer support, becomes vital in self-management programs preparing patients with VAD for their home environment.
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Affiliation(s)
- Florian Treß
- Albert-Ludwigs University of Freiburg, Faculty of Medicine, Institute of Nursing Science, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Christine Spitz-Koeberich
- Medical Center-University of Freiburg, University Heart Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Anne Rebafka
- Albert-Ludwigs University of Freiburg, Faculty of Medicine, Institute of Nursing Science, Breisacher Str. 153, 79110 Freiburg, Germany
| | - David Schibilsky
- Medical Center-University of Freiburg, University Heart Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Christiane Kugler
- Albert-Ludwigs University of Freiburg, Faculty of Medicine, Institute of Nursing Science, Breisacher Str. 153, 79110 Freiburg, Germany
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