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Hough R, Dunn JL, Hepburn LA. Re-imagining the future state of the ventricular assist device controller interface through human-centered design. Artif Organs 2024. [PMID: 39016684 DOI: 10.1111/aor.14817] [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: 02/03/2024] [Revised: 06/01/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Ventricular assist devices (VADs) are effective therapy for patients with end-stage heart failure. Current VAD controllers offer improved interactivity, yet limitations of the visual, tactile, and auditory interface persist that impact patient experience and quality of life (QoL). This study explores how VAD controllers can be redesigned using a human-centered design approach to enhance the emotional and functional experience of the device for patients. METHODS VAD patients (n = 21), caregivers (n = 4) and healthcare practitioners (n = 24) were interviewed to uncover design opportunities. From this, a series of realistic scenarios to design for emerged. A "design by analogy" method took inspiration from existing consumer products to ideate new functionality for the VAD wearable system, creating concepts for a controller interface and paired wearable device. An additional 15 patients and 2 caregivers were engaged to explore current VAD controller experiences and evaluate the future-state concepts. RESULTS This research validated the need for increased automation and emergency functionality in VAD controllers, including remote monitoring of data, accurate communication of battery status, and automated medical alerts for critical device alarms. "Manage my health," "Feeling normal," "Social belonging," "Feeling safe," and "Sense of control" emerged as key patient concerns to be met by future VAD controller designs. CONCLUSIONS The study demonstrated an innovative and relevant approach to improve usability of future VAD peripherals. By considering both emotional and functional perspectives in the design of lifesaving medical devices such as VADs, device manufacturers can uncover new opportunities to improve patient QoL through improved user experiences.
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Affiliation(s)
- Rosie Hough
- School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Lea Dunn
- School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
| | - Leigh-Anne Hepburn
- School of Architecture, Design and Planning, University of Sydney, Sydney, New South Wales, Australia
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2
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Van Zyl JS, Shelton C, Alam K, Parker L, Jamil AK, Felius J, Mathew C, Carey SA, Funk C, Warren AM, Joseph SM, Hall SA, Alam A. Sexual Quality of Life in Left Ventricular Assist Device Patients and Their Partners. J Card Fail 2024:S1071-9164(24)00158-1. [PMID: 38754697 DOI: 10.1016/j.cardfail.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Living with a left ventricular assist device (LVAD) comes with potentially burdensome aspects posed by, for example, battery packs and device drivelines. We aim to describe the impact of living with a durable LVAD on sexual quality of life (QOL), depression, and anxiety in patients and their partners. METHODS AND RESULTS In this single-center, prospective, observational study, patients ≥4 months after LVAD implantation and their partners completed the Sexual Activities in Left Ventricular Assist Device Patients or Partners questionnaire to assess their sexual QOL, the 8-item Patient Health Questionnaire (PHQ-8) to assess symptoms of depression and the 7-item Generalized Anxiety Disorder (GAD-7) to assess symptoms of anxiety. Sixty patients and 60 partners completed the questionnaires 2.3 ± 1.9 years after implantation. Eighty-seven percent of the patients and 13% of partners were male. The mean age of patients was 57.4 ± 13.3 years, with 90% living with their partner. Ten percent of patients and 18% of partners had a current diagnosis of a psychological condition, most frequently depression and/or anxiety. Overall, 49% of participants indicated the LVAD influenced their sexual activity (patients 53% vs partners 45%; P = .33). Disturbances from the driveline were the most common problem indicated. Twenty-four percent of participants had scored in the mild to moderate depression range on the PHQ-8 and 28% scored in the mild to severe anxiety range on the GAD-7. The median total GAD-7 (1 [interquartile range (IQR) 0-4.25] vs 2.5 [IQR 0-5]; P = .06) were comparable between patients and partners; whereas patients had a higher total PHQ-8 score (3 [IQR 0-5.25] vs 1 [IQR 0-3.25]; P = .02). A preference to receive information regarding sexuality while on LVAD support was indicated by 54% of participants and did not differ between patients and partners (P > .99). Written resources were the most commonly preferred source of information. CONCLUSIONS LVADs severely affect the sexual QOL for patients and their partners. The presence of a driveline is a major cause for concern. Patients prefer receiving written information on how to improve their sexual QOL.
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Affiliation(s)
- Johanna S Van Zyl
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Texas A&M University College of Medicine Health Science Center, Dallas, Texas
| | - Catherine Shelton
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Komal Alam
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Lesia Parker
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Aayla K Jamil
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Texas A&M University College of Medicine Health Science Center, Dallas, Texas
| | - Joost Felius
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Texas A&M University College of Medicine Health Science Center, Dallas, Texas
| | - Christo Mathew
- Texas A&M University College of Medicine Health Science Center, Dallas, Texas
| | - Sandra A Carey
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | | | - Ann Marie Warren
- Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Susan M Joseph
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University College of Medicine Health Science Center, Dallas, Texas; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Amit Alam
- Division of Cardiology, New York University Langone Health, New York, New York.
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3
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D'Andria Ursoleo J, Pieri M, Calvo F, Altizio S, Gramegna M, Pontillo D, Ajello S, Scandroglio AM. Long-term quality of life, psychological distress, and caregiver burden in octogenarians with LVAD: A single-centre experience. Int J Artif Organs 2024; 47:303-308. [PMID: 38520143 DOI: 10.1177/03913988241239236] [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] [Indexed: 03/25/2024]
Abstract
With the general population aging, both life expectancy and the number of left ventricular assist device (LVAD) implantations in elderly patients are growing. Nevertheless, their perceived long-term quality of life, including psychological aspects, coupled with the respective caregiver's burden, remain under-reported. In light of the rising number of octogenarians with LVAD who necessitate broader healthcare provider involvement, we assessed the long-term quality of life, as defined by both the 36-item short-form health (SF-36) survey and the EuroQol 5 dimensions, 5-level questionnaire (EQ-5D-5L)-including the visual analog scale-in octogenarian LVAD patients who had received treatment at our institution. Additionally, we evaluated the psychological health of octogenarian LVAD patients using the psychological general well-being index (PGWBI), alongside their caregivers' well-being through the 22-item version of the Zarit Burden Interview (ZBI). Of 12 octogenarian LVAD patients, 5 were alive and willing to answer questionnaires. Mean age at implant was 74 ± 2 years. Median follow-up was 2464 (IQR = 2375-2745) days. Although variable, the degree of health and psychological well-being perceived by octogenarian patients with LVAD was "good." Interestingly, the burden of assistance reported by caregivers, though relevant, was greatly varied, suggesting the need to better define and address psychological long-term aspects related to LVAD implantation for both patients and caregivers with a broad-spectrum approach.
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Affiliation(s)
- Jacopo D'Andria Ursoleo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
- Vita-Salute San Raffaele University, Milan, Lombardia, Italy
| | - Francesco Calvo
- Department of Acute Cardiac Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Savino Altizio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Mario Gramegna
- Department of Acute Cardiac Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Domenico Pontillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Silvia Ajello
- Department of Acute Cardiac Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
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4
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Gokhale S, Malesz A, Masha L. Ventricular Arrhythmias and Sudden Cardiac Death in Left Ventricular Assist Device Patients Without Implantable Cardioverter Defibrillators. ASAIO J 2024:00002480-990000000-00435. [PMID: 38457484 DOI: 10.1097/mat.0000000000002177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Patients with left ventricular assist devices (LVAD) can develop sustained ventricular arrhythmias (VA). The history and presentation of VA in implantable cardioverter defibrillator (ICD)-naive patients with LVAD is not well described in the literature and the risks/benefits of ICD implantation are unknown. This single-center retrospective cohort study included patients >18 years old who did not have an ICD during LVAD implantation from 2010 to 2022. The primary outcome was VA event rate per 100 patient-years. Two hundred thirty-seven patients underwent LVAD implantation and we identified 46 (19.4%) ICD naive patients. The etiology of heart failure in most patients was nonischemic cardiomyopathy (67.4%). Of all patients, only five were found to have documented VA. Only two episodes of VA occurred in the ambulatory setting. The estimated index VA rate was 5.89 events per 100 patient-years in our entire ICD-naive LVAD population. In the ambulatory ICD-naive population, the estimated VA rate was 2.42 events per 100 patient-years with no associated mortality. The rate of index VA in ICD-naive patients was below thresholds associated with benefits from ICD insertion. No ambulatory mortality from VA was seen and VA was well tolerated by the LVAD population. Perioperative VA in this population is associated with high mortality.
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Affiliation(s)
- Sanket Gokhale
- From the Division of Cardiology, Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon
| | - Alexandra Malesz
- Department of Internal Medicine, Oregon Health Science University, Portland, Oregon
| | - Luke Masha
- From the Division of Cardiology, Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon
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5
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Inyom C, Haese T, Schoenrath F, Potapov E, Knierim J. Lived experiences of patients implanted with left ventricular assist devices. Heart Lung 2022; 55:155-161. [PMID: 35605356 DOI: 10.1016/j.hrtlng.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Besides survival, improvement in quality of life (QoL) is a major aim of left ventricular assist device (LVAD) implantation. QoL assessment tools in current use are effective in the gathering of standardized metrics but are limited in their ability to elucidate everyday lived patient experiences that also affect overall patient wellbeing. OBJECTIVE To describe and understand the lived experiences of patients undergoing long-term circulatory support with LVAD. METHODS A phenomenological approach was used. Purposive sampling of consecutive willing inpatients and outpatients living with an LVAD for longer than 6 months was conducted until theme saturation. There were a total of 21 patients interviewed and this was then recorded and transcribed. RESULTS A total of eight themes emerged from the data. Overall, the patients' quality of life was affected by: (1) whether they had experienced improvements or setbacks in their recent health condition, (2) experiencing burdens from their device such as weight and handling, (3) limitations in their physical ability such as participating in sports, their inability to work; or reduced sleep, (4) reduced social interactions; (5) reduction in sexual activity and performance; (6) experiencing emotional and psychological problems and experiencing anxiety. Patients highlighted the value of obtaining (7) support from family and friends. The interviews also revealed that some patients experienced the feeling of (8) optimism and obtaining "a second chance" at life. CONCLUSIONS LVAD patients have unique concerns and lived experiences. Some themes emerging from this interview series such as having to give up work, having reduced social contact, reduced sexual activity and emotional problems, family support structures demand careful attention during the pre-implantation counselling and post implantation ongoing care. These aspects also deserve more attention in quality of life studies among LVAD patients. Patients with recent improvements in health reported a more positive outlook. Overall the majority of patients reported feeling that they obtained a second chance at life.
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Affiliation(s)
- Charity Inyom
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin: Deutsches Herzzentrum Berlin, Berlin, Germany.
| | - Thomas Haese
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin: Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin: Deutsches Herzzentrum Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin: Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin: Deutsches Herzzentrum Berlin, Berlin, Germany
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6
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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.
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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
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7
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Verkaik NJ, Yalcin YC, Bax HI, Constantinescu AA, Brugts JJ, Manintveld OC, Birim O, Croughs PD, Bogers AJJC, Caliskan K. Single-Center Experience With Protocolized Treatment of Left Ventricular Assist Device Infections. Front Med (Lausanne) 2022; 9:835765. [PMID: 35685416 PMCID: PMC9171101 DOI: 10.3389/fmed.2022.835765] [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: 12/14/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Because of the current lack of evidence-based antimicrobial treatment guidelines, Left Ventricular Assist Device (LVAD) infections are often treated according to local insights. Here, we propose a flowchart for protocolized treatment, in order to improve outcome. Methods The flowchart was composed based on literature, consensus and expert opinion statements. It includes choice, dosage and duration of antibiotics, and indications for suppressive therapy, with particular focus on Staphylococcus aureus (SA) (Figure 1). The preliminary treatment results of 28 patients (2 from start cephalexin suppressive therapy) after implementation in July 2018 are described. Results Cumulative incidence for first episode of infection in a 3-year time period was 27% (26 of 96 patients with an LVAD). Twenty-one of 23 (91%) first episodes of driveline infection (10 superficial and 13 deep; nine of 13 caused by SA) were successfully treated with antibiotics according to flowchart with complete resolution of clinical signs and symptoms. For two patients with deep driveline infections, surgery was needed in addition. There were no relapses of deep driveline infections, and only 2 SA deep driveline re-infections after 6 months. Nine patients received cephalexin of whom four patients (44%) developed a breakthrough infection with cephalexin-resistant gram-negative bacteria. Conclusions The first results of this protocolized treatment approach of LVAD infections are promising. Yet, initiation of cephalexin suppressive therapy should be carefully considered given the occurrence of infections with resistant micro-organisms. The long-term outcome of this approach needs to be established in a larger number of patients, preferably in a multi-center setting.
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Affiliation(s)
- Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Rotterdam, Netherlands
| | - Yunus C Yalcin
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands.,Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Hannelore I Bax
- Department of Medical Microbiology and Infectious Diseases, Rotterdam, Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
| | - Ozcan Birim
- Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Peter D Croughs
- Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
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8
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Peng DM, Yu S, Lowery R, Ventresco C, Cousino MK, St Louis JD, Blume ED, Uzark K. Self-reported quality of life in children with ventricular assist devices. Pediatr Transplant 2022; 26:e14237. [PMID: 35102660 DOI: 10.1111/petr.14237] [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] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to describe QOL in children with VAD and to identify factors associated with impaired QOL. METHODS There were 82 children (6-19 years) in the Pediatric Interagency Registry for Mechanical Circulatory Support who completed the PedsQL +/- a VAD-specific QOL assessment pre-VAD implant (n = 18), 3 months post-VAD (n = 63), and/or 6 months post-VAD (n = 38). Significantly impaired QOL is a score >1 SD below norms. RESULTS Study patients were 59% male, 67% Caucasian, with cardiomyopathy diagnosis in 82%, and median age at implant of 14 y (IQR 11-17). PedsQL scores were lower than norms for physical (p < .0001) and psychosocial (p < .01) QOL in pre- and post-VAD groups. Compared to chronic health condition and complex or severe heart disease groups, PedsQL scores were lower for physical and psychosocial QOL in the pre-VAD group (p < .0001); however, psychosocial QOL was not significantly different in post-VAD groups. Psychosocial QOL was impaired in 67%, 40%, and 24% in pre-VAD, 3-month, and 6-month post-VAD groups, respectively. Total and psychosocial QOL scores were significantly higher in the 3-month and 6-month post-VAD group than pre-VAD (all p ≤ .02). VAD patients were most bothered by their inability to participate in usual play activities. Impaired QOL 3 months post-VAD was associated with inotropic support >2 weeks/ongoing post-VAD (p = .04). CONCLUSION Physical QOL is significantly impaired in most children pre- and post-VAD. However, psychosocial QOL is not significantly impaired in most children post-VAD suggesting VAD implantation may improve psychosocial QOL in children.
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Affiliation(s)
- David M Peng
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Sunkyung Yu
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Ray Lowery
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Courtney Ventresco
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Melissa K Cousino
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - James D St Louis
- Department of Surgery, Medical College of Georgia, Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Karen Uzark
- Department of Pediatrics (Cardiology), CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
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9
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Krimminger DM, Sledge JA. A qualitative study of life with a left ventricular assist device as a bridge to transplant: A new normal. Intensive Crit Care Nurs 2022; 71:103230. [DOI: 10.1016/j.iccn.2022.103230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 11/05/2022]
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10
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Suzuki F, Sato H, Akiyama M, Akiba M, Adachi O, Harada T, Saiki Y, Kohzuki M. Changes in the Quality of Life of Patients with Left Ventricular Assist Device and Their Caregivers in Japan: Retrospective Observational Study. TOHOKU J EXP MED 2022; 257:45-55. [PMID: 35354693 DOI: 10.1620/tjem.2022.j016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Fumika Suzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Hiroe Sato
- Health Administration Centerr, Niigata University
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Miki Akiba
- Division of Organ Transplantation, Tohoku University Hospital
| | - Osamu Adachi
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Taku Harada
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
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11
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Sato T, Kobayashi Y, Nagai T, Nakatani T, Kobashigawa J, Saiki Y, Ono M, Wakasa S, Anzai T. Long-term preservation of functional capacity and quality of life in advanced heart failure patients with bridge to transplant therapy: A report from Japanese nationwide multicenter registry. Int J Cardiol 2022; 356:66-72. [PMID: 35337935 DOI: 10.1016/j.ijcard.2022.03.044] [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: 11/22/2021] [Revised: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients. METHODS We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO2], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation. RESULTS During the follow-up period of 30 months (IQR 18-42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO2, 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively). CONCLUSIONS BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx.
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Affiliation(s)
- Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | | | - Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Minoru Ono
- Department of Cardiovascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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12
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Cho SM, Floden D, Wallace K, Hiivala N, Joseph S, Teuteberg J, Rogers JG, Pagani FD, Mokadam N, Tirschwell D, Li S, Starling RC, Mahr C, Uchino K. Long-Term Neurocognitive Outcome in Patients With Continuous Flow Left Ventricular Assist Device. JACC-HEART FAILURE 2021; 9:839-851. [PMID: 34509403 DOI: 10.1016/j.jchf.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors sought to examine the long-term cognitive outcome of patients with continuous flow left ventricular assist device (CF-LVAD). BACKGROUND Data on long-term neurocognitive outcome in LVAD are limited. We examined the neurocognitive outcome of patients who received a CF-LVAD as destination therapy. METHODS Patients with HeartWare (HVAD) and HeartMate II who were enrolled in the ENDURANCE and ENDURANCE Supplemental trials were eligible. Cognition was evaluated with neuropsychological testing preoperatively and at 6, 12, and 24 months after implantation. General linear models identified demographic, disease, and treatment factors that predicted decline on each neurocognitive measure. RESULTS Of 668 patients who completed baseline testing and at least 1 follow-up evaluation, 552 were impaired at baseline on at least 1 cognitive measure. At each follow-up, approximately 23% of tested patients declined and 20% improved relative to baseline on at least 1 cognitive measure. Of those who were intact at baseline, only 10%-12% declined in delayed memory and 11%-16% declined in executive function at all 3 follow-ups. For patients impaired at baseline, delayed memory decline was associated with the HVAD device and male sex, whereas executive function decline was associated with the HVAD device and stroke during CF-LVAD support. For patients intact at baseline, male sex and history of hypertension were associated with decline in immediate memory and executive function, respectively. CONCLUSIONS Neurocognitive function remained stable or improved for most patients (∼80%) with CF-LVAD at 6, 12, and 24 months after implantation. Male sex, hypertension, HVAD, and stroke were associated with cognitive decline.
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Affiliation(s)
- Sung-Min Cho
- Neurocritical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Darlene Floden
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Susan Joseph
- Department of Cardiology, Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Jeffrey Teuteberg
- Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Joseph G Rogers
- Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nahush Mokadam
- Department of Cardiac Surgery, The Ohio State University, Columbus, Ohio, USA
| | - David Tirschwell
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Song Li
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Randall C Starling
- Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Ken Uchino
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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13
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Cho SM, Mehaffey JH, Meyers SL, Cantor RS, Starling RC, Kirklin JK, Jacobs JP, Kern J, Uchino K, Yarboro LT. Cerebrovascular Events in Patients With Centrifugal-Flow Left Ventricular Assist Devices: Propensity Score-Matched Analysis From the Intermacs Registry. Circulation 2021; 144:763-772. [PMID: 34491776 DOI: 10.1161/circulationaha.121.055716d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic and hemorrhagic cerebrovascular accidents remain common among patients with centrifugal-flow left ventricular assist devices, despite improvements in survival and device longevity. We compared the incidence of neurologic adverse events (NAEs) associated with 2 contemporary centrifugal-flow left ventricular assist devices: the Abbott HeartMate3 (HM3) and the Medtronic HeartWare HVAD (HVAD). METHODS Using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), we collected data on adult patients who received a centrifugal-flow left ventricular assist device as a primary isolated implant between January 1, 2017, and September 30, 2019. Major NAEs were defined as transient ischemic attack, ischemic cerebrovascular accident, or hemorrhagic cerebrovascular accident. The association of HVAD with risk of NAE in the first year after implant was evaluated using propensity score matching to balance for preimplant risk factors. After matching, freedom from first major NAE in the HM3 and HVAD cohorts was compared with Kaplan-Meier curves. A secondary analysis using multivariable multiphase hazard models was used to identify predictors of NAE, which uses a data-driven parametric fit of the early declining and constant phase hazards and the associations of risk factor with either phase. RESULTS Of 6205 included patients, 3129 (50.4%) received the HM3 and 3076 (49.6%) received the HVAD. Median follow-up was 9 and 12 months (HM3 and HVAD, respectively). Patients receiving HVAD had more major NAEs (16.4% versus 6.4%, P<0.001) as well as each subtype (transient ischemic attack: 3.3% versus 1.0%, P<0.001; ischemic cerebrovascular accident: 7.7% versus 3.4%, P<0.001; hemorrhagic cerebrovascular accident: 7.2% versus 2.0%, P<0.001) than did patients receiving HM3. A propensity-matched cohort balanced for preimplant risk factors showed that HVAD was associated with higher probabilities of major NAEs (% freedom from NAE 82% versus 92%, P<0.001). Device type was not significantly associated with NAEs in the early hazard phase, but HVAD was associated with higher incidence of major NAEs during the constant hazard phase (hazard ratio, 5.71 [CI, 3.90-8.36]). CONCLUSIONS HM3 is associated with lower hazard of major NAEs than is HVAD beyond the early postimplantation period and during the constant hazard phase. Defining the explanation for this observation will inform device selection for individual patients.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.-M.C.)
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville (J.H.M., J.K., L.T.Y.)
| | - Susan L Meyers
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham (S.L.M., R.S.C., J.K.K.)
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham (S.L.M., R.S.C., J.K.K.)
| | | | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham (S.L.M., R.S.C., J.K.K.)
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville (J.P.J.)
| | - John Kern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville (J.H.M., J.K., L.T.Y.)
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute (K.U.), Cleveland Clinic, OH
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville (J.H.M., J.K., L.T.Y.)
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14
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Brown KD, Shirkey HW, Shock T, Thornton K, Rafael-Yarihuaman AE, Bindra A. Impact of symptom-guided, progressive cardiac rehabilitation after left ventricular assist device implantation. Proc (Bayl Univ Med Cent) 2021; 34:631-633. [PMID: 34456497 DOI: 10.1080/08998280.2021.1918816] [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: 10/21/2022] Open
Abstract
A 29-year-old woman with a left ventricular assist device (LVAD) completed a progressive, symptom-limited cardiac rehabilitation program consisting of boxing, weight-lifting, and aerobic exercise, where she improved her exercise capacity by 2.7 metabolic equivalents (P < 0.001) and demonstrated significant myocardial recovery, allowing for successful LVAD explant 9 months after implantation.
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Affiliation(s)
- Katelyn D Brown
- Department of Cardiac Rehabilitation, Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Heath W Shirkey
- Department of Cardiac Rehabilitation, Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Tiffany Shock
- Department of Cardiac Rehabilitation, Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Katherine Thornton
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | | | - Amarinder Bindra
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas
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15
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Patient names for mechanical circulatory support devices: Developing emotional insights. Heart Lung 2021; 50:953-967. [PMID: 34438307 DOI: 10.1016/j.hrtlng.2021.08.003] [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: 01/14/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
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.
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16
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Tigges-Limmer K, Sitzer M, Gummert J. Perioperative Psychological Interventions in Heart Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:339-345. [PMID: 34180796 DOI: 10.3238/arztebl.m2021.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/14/2020] [Accepted: 12/17/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Heart surgery is a source of high levels of emotional distress for the patient. If the stress experience is not adequately compensated, it can have a negative impact on postoperative recovery, as can untreated comorbid mental disorders. METHODS A selective literature review on emotional distress and mental comorbidities in heart surgery patients and a scoping review on the spectrum and effectiveness of perioperative psychological interventions to compensate and reduce the stress experience. RESULTS Mental factors such as depressive symptoms or anxiety disorders are associated with an elevated risk of postoperative morbidity and mortality in patients treated for heart disease. Mental comorbidities occur more frequently in these patients than in the general population. Following the manifestation of chronic heart disease (CHD), for example, 15-20% of the patients display severe depressive disorders. A few psychotherapeutic interventions to reduce anxiety and depression, emotional distress, consumption of analgesics, and extubation time have been found effective, with low to moderate evidence quality. Many different psychological interventions have proved useful in clinical practice, including multimodal, multiprofessional interventions incorporating medications, education, sports, and exercise as well as psychosocial therapy including stress management. Individual psychotherapy during the period of acute inpatient treatment after myocardial infarction is also effective. CONCLUSION Because psychosocial factors are important, the current guidelines recommend systematic screening for mental symptoms and comorbidities in advance of heart transplantation or the implantation of ventricular assist devices (VAD). Acute psychotherapeutic interventions to reduce mental symptoms can be offered in the perioperative setting.
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17
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Cho SM, Mehaffey JH, Myers SL, Cantor RS, Starling RC, Kirklin JK, Jacobs JP, Kern J, Uchino K, Yarboro L. Cerebrovascular Events in Patients with Centrifugal-Flow Left Ventricular Assist Devices: A Propensity Score Matched Analysis from the Intermacs Registry. Circulation 2021; 144:763-772. [PMID: 34315231 DOI: 10.1161/circulationaha.121.055716] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ischemic and hemorrhagic cerebrovascular accidents (ICVA and HCVA, respectively) remain common among patients with centrifugal-flow left ventricular assist devices (CF-LVADs), despite improvements in survival and device longevity. Therefore, the incidence of neurological adverse events (NAEs) associated with two contemporary CF-LVADs, the Abbott HeartMate3® (HM3) and the Medtronic HeartWare™ HVAD® (HVAD), were compared. Methods: Using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs), we collected data on adult patients who received a CF-LVAD as a primary isolated implant between 1/1/2017 and 9/30/2019. Major NAEs were defined as transient ischemic attack (TIA), ICVA, and HCVA. The association of HVAD with risk of NAE in the first year post implant was evaluated using propensity score matching to balance for pre-implant risk factors. After matching, freedom from first major NAE in the HM3 and HVAD cohorts was compared with Kaplan-Meier curves. A secondary analysis using multivariable multiphase hazard models was used to identify predictors of NAE, which uses a data driven parametric fit of the early declining and constant phase hazards and the associations of risk factor with either phase. Results: Of 6,205 included patients, 3,076 (49.6%) received the HM3 and 3,129 (50.4%) received the HVAD. Median follow-up was 9 and 12 months (HM3 and HVAD). HVAD patients had more major NAEs (16.4% vs. 6.4%, p<0.001), as well as each subtype (TIA: 3.3% vs. 1.0%, p<0.001; ICVA: 7.7% vs. 3.4%, p<0.001; and HCVA: 7.2% vs. 2.0%, p<0.001), than did HM3 patients. A propensity-matched cohort balanced for pre-implant risk factors showed that HVAD was associated with higher probabilities of major NAEs (% freedom from NAE: 82% vs. 92%, p<0.001). Device type was not significantly associated with NAEs in the early hazard phase, but HVAD was associated with higher incidence of major NAEs during the constant hazard phase (hazard ratio: 5.71, confidence interval: 3.90-8.36). Conclusions: HM3 is associated with lower hazard of major NAEs than is HVAD beyond the early post-implantation period and during the constant hazard phase. Defining the explanation for this observation will inform device selection for individual patients.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Susan L Myers
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL
| | | | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - John Kern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Leora Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
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18
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Bhagra SK, Pettit S, Parameshwar J. Implantable left ventricular assist device: indications, eligibility and current outcomes. Heart 2021; 108:233-241. [PMID: 34099466 DOI: 10.1136/heartjnl-2020-317886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sai Kiran Bhagra
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen Pettit
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jayan Parameshwar
- Advanced Heart Failure and Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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19
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Bottle A, Faitna P, Aylin PP, Cowie MR. Five-year outcomes following left ventricular assist device implantation in England. Open Heart 2021; 8:openhrt-2021-001658. [PMID: 33975872 PMCID: PMC8117985 DOI: 10.1136/openhrt-2021-001658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 01/21/2023] Open
Abstract
Objective Implant rates of mechanical circulatory supports such as left ventricular assist devices (LVAD) have steadily increased in the last decade. We assessed the utility of administrative data to provide information on hospital use and outcomes. Methods Using 2 years of national hospital administrative data for England linked to the death register, we identified all patients with an LVAD and extracted hospital activity for 5 years before and after the LVAD implantation date. Results In the two index years April 2011 to March 2013, 157 patients had an LVAD implanted. The mean age was 50.9 (SD 15.4), and 78.3% were men. After 5 years, 92 (58.6%) had died; the recorded cause of death was noncardiovascular in 67.4%. 42 (26.8%) patients received a heart±lung transplantation. Compared with the 12 months before implantation, the 12 months after but not including the month of implantation saw falls in total inpatient and day case admissions, a fall in admissions for heart failure (HF), a rise in non-HF admissions, a fall in emergency department visits not ending in admission and a rise in outpatient appointments (all per patient at risk). Postimplantation complications were common in the subsequent 5 years: 26.1% had a stroke, 23.6% had a device infection and 13.4% had a new LVAD implanted. Conclusions Despite patients’ young age, their mortality is high and their hospital use and complications are common in the 5 years following LVAD implantation. Administrative data provide important information on resource use in this patient group.
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Affiliation(s)
- Alex Bottle
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Puji Faitna
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Paul P Aylin
- General Practice and Public Health, Imperial College London, London, UK
| | - Martin R Cowie
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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20
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Austin MA, Saxena A, O'Malley TJ, Maynes EJ, Moncure H, Ott N, Massey HT, Moscato F, Loforte A, Stulak JM, Tchantchaleishvili V. Computational sentiment analysis of an online left ventricular assist device support forum: positivity predominates. Ann Cardiothorac Surg 2021; 10:375-382. [PMID: 34159118 DOI: 10.21037/acs-2020-cfmcs-fs-11] [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] [Indexed: 11/06/2022]
Abstract
Background The impact of left ventricular assist device (LVAD) complications on the individual patient, overall sentiment, and its effect on referral patterns, is not fully understood. We sought to better understand patient attitudes towards LVAD therapy using a computational sentiment analysis approach. Methods Posts, comments, and titles were parsed from MyLVAD.com's HTML as a text file using custom Python scripts (version 3.6). Individual word frequency was computed with word classification as 'positive', 'negative', or 'neutral'. Data transformation and cleaning, sentiment determination, and analysis was performed with a binary dictionary package using R software (version 3.6). Results Sixty-six thousand eight hundred and twenty-one unique words were noted, including 4,623 (6.9%) with positive sentiment and 3,248 (4.8%) with negative sentiment. Net sentiment ratio [(number of positive words - number of negative words)/(number of total words)] was 2.1%. Positive sentiment dominated the 20 most commonly used words. Odds ratio of non-neutral words [(number of positive words/number of negative words)] was 1.42, indicating a less obvious disparity in sentiment when expanding analysis beyond the top 20 words. Word cloud analysis of positive and negative sentiments was performed, indicating common use of "infection" (208 mentions) compared to other complications such as "stroke" (29 mentions), "bleeding" (30 mentions), and "thrombosis" or "clot" (32 mentions). Conclusions Positive sentiment dominates the most frequently used words, yet this disparity decreases when considering the totality of words. "Infection" is mentioned a disproportionate number of times compared to other LVAD complications. Further research is required to address analysis limitations, including selection bias.
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Affiliation(s)
- Melissa A Austin
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Abhiraj Saxena
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thomas J O'Malley
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Henry Moncure
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nathan Ott
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Antonio Loforte
- Department of Cardio-Thorac-Vascular Surgery, St. Orsola Hospital, Bologna University, Bologna, Italy
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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21
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Cho SM, Tahsili-Fahadan P, Kilic A, Choi CW, Starling RC, Uchino K. A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device-Associated Stroke. Semin Neurol 2021; 41:411-421. [PMID: 33851393 DOI: 10.1055/s-0041-1726328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnostic approach, and discuss treatment strategies.
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Affiliation(s)
- Sung-Min Cho
- Division of Neurocritical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pouya Tahsili-Fahadan
- Division of Neurocritical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Neuroscience Intensive Care Unit, Department of Medicine, Virginia Commonwealth University, Inova Fairfax Medical Campus, Falls Church, Virginia.,Neuroscience Research, Neuroscience and Spine Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Ahmet Kilic
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chun Woo Choi
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ken Uchino
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Itzhaki Ben Zadok O, Ben-Avraham B, Jaarsma T, Shaul A, Hammer Y, Barac YD, Mats I, Eldar O, Abuhazira M, Yaari V, Gulobov D, Mulu M, Aravot D, Kornowski R, Ben-Gal T. Health-related quality of life in left ventricular assist device-supported patients. ESC Heart Fail 2021; 8:2036-2044. [PMID: 33773095 PMCID: PMC8120365 DOI: 10.1002/ehf2.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
Aims This study aimed to evaluate the different health‐related quality of life (HR‐QoL) aspects in patients with both short‐term and long‐term duration LVAD support at pre‐specified time intervals. Methods and results We performed a single‐centre HR‐QoL analysis of short‐term and long‐term LVAD‐supported patients using the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ‐12) and the Changes in Sexual Functioning Questionnaire along with a survey to evaluate patients' social and driving routines. Data were collected at baseline and at 6 or 12 month follow‐up. Included were 46 patients with a median time from LVAD implantation of 1.1 [inter‐quartile range (IQR) 0.5, 2.6] years. The median KCCQ‐12 summary score was 56 (IQR 29, 74) with most favourable scores in the symptom frequency domain [75 (IQR 50, 92)] and worse scores in the physical limitation [42 (IQR 25, 75)] and QoL [44 (IQR 25, 75)] domains. No significant changes were apparent during study follow‐up [KCCQ‐12 summary score 56 (IQR 35, 80)], and no significant correlation between the KCCQ‐12 summary score and ventricular assist device‐support duration was detected (r = −0.036, P = 0.812). Sexual dysfunction was noted across all domains with a cumulative score of 31 (IQR 22, 42). Seventy‐six per cent of patients resumed driving after LVAD implantation, and 43% of patients reported they socialize with family and friends more frequently since surgery. Conclusions Short‐term and long‐term LVAD‐supported patients had impaired HR‐QoL and sexual function at baseline and at follow‐up yet reported an improvement in social interactions and independency. A broader spectrum of patient's reported HR‐QoL measures should be integrated into the pre‐LVAD implantation assessment and preparation.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben-Avraham
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tiny Jaarsma
- Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Medicine, Health and Care, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Aviv Shaul
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Hammer
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron D Barac
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Israel Mats
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Eldar
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel
| | - Miriam Abuhazira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Vicky Yaari
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dmitry Gulobov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Mastwal Mulu
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel
| | - Dan Aravot
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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A systematic review of psychosocial design considerations for the next generation of mechanical circulatory support. Heart Lung 2021; 50:397-406. [PMID: 33621838 DOI: 10.1016/j.hrtlng.2021.01.021] [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: 10/08/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
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.
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Abstract
Heart failure (HF) is a frequent cause of morbidity and mortality worldwide. The prevalence of HF increases, and in high-income countries, 1-2% of total healthcare expenditure is spent on HF. This article gives an overview on the impact of HF on health-related quality of life (HRQoL) and the economic burden of HF. Those suffering from HF are associated with a substantial decrease of HRQoL compared to individuals with most other chronic diseases and to individuals without HF. Therapeutic approaches, which decrease risk factors and lead to an improvement of the clinical status of patients, have a positive effect on HRQoL of the patients. Hospitalization rates have been shown to be correlated with disease severity, mortality, and HRQoL. Inpatient treatments of HF patients are cost intensive and the most important component for the economic burden of HF, responsible for at least half of direct cost. Prevention strategies, diagnostic and therapeutic approaches should focus on avoiding need for hospitalizations, and in particular, readmissions. Outpatient care including medication represents the second largest cost component. The cost of HF varies from less than 1,000 USD per patient in low-income countries to between 5,000 and 15,000 EUR in Europe, and between 17,000 and 30,000 USD in the US. There is a lack of study results on indirect costs. All study results on the socio-economic burden of HF clearly underscore the public health relevance of HF, showing a large economic burden for healthcare systems all over the world and a considerable impact on patients' HRQoL. The results on HRQoL are relatively homogeneous, but there are large differences across countries in respect of the economic burden they have to bear. Despite the large number of studies on the socio-economic consequences of HF further research is necessary, especially on indirect cost and for low- and middle-income countries. Future studies would benefit from a greater standardization of methods and presentation of results.
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Affiliation(s)
- Franz P Hessel
- SRH Berlin University of Applied Science, Berlin, Germany
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25
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Thongprayoon C, Lertjitbanjong P, Cheungpasitporn W, Hansrivijit P, Fülöp T, Kovvuru K, Kanduri SR, Davis PW, Vallabhajosyula S, Bathini T, Watthanasuntorn K, Prasitlumkum N, Chokesuwattanaskul R, Ratanapo S, Mao MA, Kashani K. Incidence and impact of acute kidney injury on patients with implantable left ventricular assist devices: a Meta-analysis. Ren Fail 2020; 42:495-512. [PMID: 32434422 PMCID: PMC7301695 DOI: 10.1080/0886022x.2020.1768116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background: We aimed to evaluate the acute kidney injury (AKI) incidence and its associated risk of mortality in patients with implantable left ventricular assist devices (LVAD).Methods: A systematic literature search in Ovid MEDLINE, EMBASE, and Cochrane Databases was conducted through January 2020 to identify studies that provided data on the AKI incidence and AKI-associated mortality risk in adult patients with implantable LVADs. Pooled effect estimates were examined using random-effects, generic inverse variance method of DerSimonian-Laird.Results: Fifty-six cohort studies with 63,663 LVAD patients were enrolled in this meta-analysis. The pooled incidence of reported AKI was 24.9% (95%CI: 20.1%-30.4%) but rose to 36.9% (95%CI: 31.1%-43.1%) when applying the standard definition of AKI per RIFLE, AKIN, and KDIGO criteria. The pooled incidence of severe AKI requiring renal replacement therapy (RRT) was 12.6% (95%CI: 10.5%-15.0%). AKI incidence did not differ significantly between types of LVAD (p = .35) or indication for LVAD use (p = .62). While meta-regression analysis did not demonstrate a significant association between study year and overall AKI incidence (p = .55), the study year was negatively correlated with the incidence of severe AKI requiring RRT (slope = -0.068, p < .001). The pooled odds ratios (ORs) of mortality at 30 days and one year in AKI patients were 3.66 (95% CI, 2.00-6.70) and 2.22 (95% CI, 1.62-3.04), respectively. The pooled ORs of mortality at 30 days and one year in severe AKI patients requiring RRT were 7.52 (95% CI, 4.58-12.33) and 5.41 (95% CI, 3.63-8.06), respectively.Conclusion: We found that more than one-third of LVAD patients develop AKI based on standard definitions, and 13% develop severe AKI requiring RRT. There has been a potential improvement in the incidence of severe AKI requiring RRT for LVAD patients. AKI in LVAD patients was associated with increased 30-day and 1 year mortality.
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Affiliation(s)
| | | | | | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Karthik Kovvuru
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Swetha R. Kanduri
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Paul W. Davis
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | | | | | | | - Supawat Ratanapo
- Division of Cardiology, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic Health System, Jacksonville, FL, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Levelink M, Eichstaedt HC, Meyer S, Brütt AL. Living with a left ventricular assist device: psychological burden and coping: protocol for a cross-sectional and longitudinal qualitative study. BMJ Open 2020; 10:e037017. [PMID: 33087369 PMCID: PMC7580038 DOI: 10.1136/bmjopen-2020-037017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Due to technological progress and persistent shortage of donor hearts, left ventricular assist devices (LVADs) have become established in the treatment of advanced heart failure. Accordingly, more patients live with LVADs for prolonged periods. Related research focused primarily on clinical issues and little is known about psychosocial aspects of living with an LVAD. This study aims to explore psychological burden and coping following LVAD implantation. METHODS AND ANALYSIS An exploratory qualitative study with cross-sectional and longitudinal elements will be carried out. At least 18 patients with LVAD who have the device implanted from a few weeks to more than 3 years will be interviewed in the cross-sectional component using an interview guide. A subsample of patients who live with the LVAD for up to 3 months when recruited will be interviewed two additional times in the following year. The cross-sectional interviews will be analysed using an inductive qualitative content analysis to describe psychological burden, coping resources and behaviour from the patient's perspective. Based on the findings, the longitudinal interviews will be analysed with a deductive content analysis to explore psychological adjustment during the first year after implantation. The findings will provide a deeper understanding of the complex and specific situation of patients with LVAD and of psychological adjustment to living with a life-sustaining implant. This can help clinicians in considering individual aspects to promote patient outcomes and is the basis for further research on healthcare interventions or technical solutions to reduce burden and for developing rehabilitation measures to promote psychosocial outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committee of the School of Medicine and Health Sciences at the University of Oldenburg (2019-023). Study findings will be disseminated at national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00016883).
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Affiliation(s)
- Michael Levelink
- Department of Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Germany
| | | | - Sven Meyer
- Department of Cardiology, Klinikum Oldenburg AöR, Oldenburg, Niedersachsen, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Germany
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Melnikov S, Abuhazira M, Golobov D, Yaari V, Jaarsma T, Ben Gal T. Factors associated with body image among patients with an implanted left ventricular assist device. Heart Lung 2020; 49:803-807. [PMID: 33010518 DOI: 10.1016/j.hrtlng.2020.08.022] [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: 05/14/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among Left Ventricular Assist Device (LVAD) implanted patients, body image modifications might occur. OBJECTIVES To explore the associations between sexual functioning, confidence in LVAD technology, personal wellbeing, and body image. METHODS The cross-sectional study included 30 conveniently recruited LVAD implanted patients who completed Body Image Scale, sexual functioning, confidence in LVAD technology, and Personal Wellbeing Index questionnaires. The associations between the research variables were examined with multiple regression analyses. RESULTS The mean age of the participants was 63 (SD=10), 90% were men. The mean scores were: sexual functioning - 2.43 (SD=1.20, range 1-5); confidence in LVAD technology - 2.63 (SD=1.04, range 1-5); Well-Being Index - 6.61 (SD=1.53, range 0-10); and body image - 14.5 (SD=4.17, range 5-20). Sexual functioning (p<.01) and LVAD technology confidence (p=.04) significantly predicted body image. CONCLUSIONS Healthcare professionals should be aware of challenges regarding body image faced by LVAD implanted patients and to address related factors.
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Affiliation(s)
- Semyon Melnikov
- Department of Nursing, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | | | | | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden.
| | - Tuvia Ben Gal
- Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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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.
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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
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Haddad O, Pham AN, Thomas M, Ali M, Sareyyupoglu B, El-Sayed Ahmed MM, Pham SM. Absorbable antibiotic beads as an adjuvant therapy in treating ventricular assist devices driveline infection: A case report. J Card Surg 2020; 35:2073-2076. [PMID: 32652630 DOI: 10.1111/jocs.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular assist devices driveline infections are common, recalcitrant, and carry high morbidity and mortality. Herein, we reported a patient with driveline infection that was successfully treated with a combination of systemic antibiotics, surgical debridement, and instillation of absorbable antibiotic beads to the wound bed. METHODS AND RESULTS A 39-year-old man with nonischemic cardiomyopathy underwent insertion of a continuous flow left ventricular assist device. Four years postoperatively, the patient presented with clinical, laboratory, and radiologic signs of driveline tract infection. He underwent extensive surgical debridement, installation of absorbable antibiotic beads that consisted of calcium sulfate, vancomycin, and tobramycin, into the wound bed, and systemic antibiotics. The patient was free of infection 9 month postoperatively. CONCLUSION Absorbable calcium sulfate antibiotic beads may serve as a beneficial adjunct to surgical debridement and systemic antibiotics for the treatment of ventricular assist device driveline infection, and merit further investigation.
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Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Anthony N Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mojahid Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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The Effect of Age on Outcomes After Destination-Therapy Left Ventricular Assist Device Implantation: An Analysis of the IMACS Registry. Can J Cardiol 2020; 37:467-475. [PMID: 32585330 DOI: 10.1016/j.cjca.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As patients with advanced heart failure are living longer, defining the impact of left ventricular assist devices (LVADs) on outcomes in an aging population is of great importance. We describe overall survival, rates of adverse events (AEs), and post-AE survival in patients age ≥ 70 years vs age 50-69 years after destination-therapy (DT) LVAD implantation. METHODS A retrospective analysis was conducted with the use of the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (IMACS) registry. All adults age ≥ 50 years with a continuous-flow DT LVAD from 2013 to 2017 were included. The primary outcome was all-cause mortality. The secondary outcomes were the incidence of and survival after gastrointestinal (GI) bleeding, infection, stroke, pump thrombosis, pump exchange, and right-side heart failure. Mortality and AEs were assessed with the use of competing risk models. RESULTS At total of 5,572 patients were included: 3,700 aged 50-69 and 1,872 aged ≥ 70. All-cause mortality by 42 months was 55.8% in patients aged ≥ 70 and 44.8% in patients aged 50-69 (P = 0.001). Patients aged ≥ 70 had a 37.8% higher risk of death after DT LVAD implantation (hazard ratio 1.378, 95% CI 1.251-1.517). Patients aged ≥ 70 had higher risk of GI bleeding but lower risk of right-side heart failure. There was no difference between age groups for risk of infection or stroke. Experiencing any AE was associated with an increased risk of death that did not vary with age. CONCLUSIONS Patients aged ≥ 70 years have reduced survival after DT LVAD, in part because of increased GI bleeding, while the incidence of other AEs is similar to that of patients aged 50-69 years. Careful patient selection beyond age alone may allow for optimal outcomes after DT LVAD implantation.
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Quality of life among patients with left ventricular assist device: Comparison of two populations. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:308-314. [PMID: 32551161 DOI: 10.5606/tgkdc.dergisi.2020.18541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate quality of life among patients with an implanted left ventricular assist device in two different populations. Methods This cross-sectional study included a total of 20 patients (15 males, 5 females; mean age 41.8±13.4 years; range, 20 to 65 years) from Turkey and 40 patients (33 males, 7 females; mean age 55.1±11.6 years; range, 21 to 76 years) from Germany who underwent left ventricular assist device implantation and reached their third month of treatment between January 2016 and August 2016. The Euro Quality of Life-5 Dimension Questionnaire and Kansas City Cardiomyopathy Questionnaire-12 were used to assess quality of life of both groups. Results Sixty-five percent of the German patients returned to work, while none of the Turkish patients returned after implantation (p=0.000). The Turkish (70%) and German (40%) patients reported that they had difficulty in living with a left ventricular assist device (p=0.028). The mean Euro Quality of Life-5 Dimension Questionnaire visual analog scale scores of the Turkish and German patients were 70.50% and 62.38%, respectively. The mean Kansas City Cardiomyopathy Questionnaire-12 scores of the Turkish patients were significantly higher than those of the German patients (p=0.01). Conclusion Left ventricular assist device implantation improved the quality of life of both Turkish and German patients. Turkish patients with left ventricular assist device should be encouraged to adopt a more independent life, not to limit their lives to home and to return to work according to their functional capacity.
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What Really Matters? Understanding Quality of Life Determinants Impacting Ventricular Assist Device Stakeholders. ASAIO J 2020; 66:626-636. [DOI: 10.1097/mat.0000000000001175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Murase S, Okazaki S, Yoshioka D, Watanabe K, Gon Y, Todo K, Sasaki T, Sakaguchi M, Misumi Y, Toda K, Sawa Y, Mochizuki H. Abnormalities of brain imaging in patients after left ventricular assist device support following explantation. J Heart Lung Transplant 2020; 39:220-227. [DOI: 10.1016/j.healun.2019.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022] Open
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Social Support Moderates the Relationship Between Perceived Stress and Quality of Life in Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2019; 33:E1-E9. [PMID: 29683872 DOI: 10.1097/jcn.0000000000000487] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Living with a left ventricular assist device has significant psychosocial sequelae that affect health-related quality of life (HRQOL). OBJECTIVE The purpose of this study was to (1) describe psychosocial indicators of stress including perceived stress, depression, fatigue, and coping; (2) examine relationships among stress indicators by level of perceived stress; (3) examine relationships among indicators of stress and clinical outcomes; and (4) test the moderation of social support on the relationship between stress and clinical outcomes. METHODS Participants were recruited from 2 outpatient clinics in a cross-sectional study design. Standardized measures were self-administered via survey. Descriptive statistics, correlation, and multiple linear regression analysis were conducted. RESULTS The sample (N = 62) was mostly male (78%), black (47%), and married (66%), with a mean age of 56.5 ± 13 years. The overall sample had a moderate stress profile: moderate perceived stress (mean, 11.7 ± 7), few depressive symptoms (mean, 3.2 ± 3.9), and moderate fatigue (mean, 14.3 ± 9.1). Increased perceived stress was associated with fatigue, depressive symptoms, and maladaptive coping (P < .001). Regression analysis demonstrated that perceived stress and fatigue were significant correlates of overall HRQOL (adj. R = 0.41, P < .0001). Social support moderated the relationship between perceived stress and HRQOL, controlling for fatigue (R = 0.49, P < .001). CONCLUSIONS Individuals living with left ventricular assist device with high perceived stress have worse depressive symptoms, fatigue, and coping. The influence of high social support to improve the relationship between stress and HRQOL underscores the importance of a comprehensive plan to address psychosocial factors.
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Ready, Set, Go: How Patients and Caregivers Are Prepared for Self-Management of an Implantable Ventricular Assist Device. ASAIO J 2019; 64:e151-e155. [PMID: 29608491 DOI: 10.1097/mat.0000000000000778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Since the first use of an implantable ventricular assist device (VAD) nearly 3 decades ago, many VAD Centers in the United States expect patients and caregivers to manage the device and related care following hospital discharge. Despite this customary practice and the rapid advancements in VAD technology, no research data about the patient and caregiver preparations exist for self-management of VAD. This study explored the process of preparing patients and caregivers for VAD care before hospital discharge along with their perceived experiences of the discharge process. Using an exploratory research design, we collected the data with self-administered demographics and VAD Hospital Discharge Survey questionnaires. We analyzed the data provided by 102 patients and 116 caregivers from different regions in the United States. Patients' mean age was 51.4 ± 13.8 years; they were predominantly White (78%); male (66%); and duration of device between 2 and 74 months. Caregivers were predominantly White (80%); female (81%); and had a mean of age 48.9 ± 12.7 years. Participants reported that their VAD care preparations, a crucial component of hospital discharge, were extensive and intensive processes comprising education, training, competency validation, and provision of resources for VAD self-management in home settings. Participants were satisfied with the process and felt prepared for discharge. Further research is needed to rectify the study limitations, advance the science of VAD self-management, and develop evidenced-based VAD self-management guidelines that are aimed at optimizing longevity of the VAD, patients' health, and quality of life.
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Stahl EP, Dickert NW, Cole RT, Laskar SR, Morris AA, Smith AL, Vega JD, Gupta D. Decisional regret in left ventricular assist device patient-caregiver dyads. Heart Lung 2019; 48:400-404. [DOI: 10.1016/j.hrtlng.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 01/11/2023]
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Yin MY, Ruckel S, Kfoury AG, McKellar SH, Taleb I, Gilbert EM, Nativi-Nicolau J, Stehlik J, Reid BB, Koliopoulou A, Stoddard GJ, Fang JC, Drakos SG, Selzman CH, Wever-Pinzon O. Novel Model to Predict Gastrointestinal Bleeding During Left Ventricular Assist Device Support. Circ Heart Fail 2019; 11:e005267. [PMID: 30571195 DOI: 10.1161/circheartfailure.118.005267] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a leading cause of morbidity during continuous-flow left ventricular assist device (CF-LVAD) support. GIB risk assessment could have important implications for candidate selection, informed consent, and postimplant therapeutic strategies. The aim of the study is to derive and validate a predictive model of GIB in CF-LVAD patients. METHODS AND RESULTS CF-LVAD recipients at the Utah Transplantation Affiliated Hospitals program between 2004 and 2017 were included. GIB associated with a decrease in hemoglobin ≥2 g/dL was the primary end point. A weighted score comprising preimplant variables independently associated with GIB was derived and internally validated. A total of 351 patients (median age, 59 years; 82% male) were included. After a median of 196 days, GIB occurred in 120 (34%) patients. Independent predictors of GIB included age >54 years, history of previous bleeding, coronary artery disease, chronic kidney disease, severe right ventricular dysfunction, mean pulmonary artery pressure <18 mm Hg, and fasting glucose >107 mg/dL. A weighted score termed Utah bleeding risk score, effectively stratified patients based on their probability of GIB: low (0-1 points) 4.8%, intermediate (2-4) 39.8%, and high risk (5-9) 83.8%. Discrimination was good in the development sample (c-index: 0.83) and after internal bootstrap validation (c-index: 0.74). CONCLUSIONS The novel Utah bleeding risk score is a simple tool that can provide personalized GIB risk estimates in CF-LVAD patients. This scoring system may assist clinicians and investigators in designing tailored risk-based strategies aimed at reducing the burden posed by GIB in the individual CF-LVAD patient and healthcare systems.
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Affiliation(s)
- Michael Yaoyao Yin
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
| | - Shane Ruckel
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
| | - Abdallah G Kfoury
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Salt Lake City, UT (A.G.K., B.B.R.)
| | - Stephen H McKellar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City (S.H.M., A.K., G.J.S., C.H.S.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
| | - Iosif Taleb
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
| | - Edward M Gilbert
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
| | - Jose Nativi-Nicolau
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
| | - Josef Stehlik
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
| | - Bruce B Reid
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Salt Lake City, UT (A.G.K., B.B.R.)
| | - Antigone Koliopoulou
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City (S.H.M., A.K., G.J.S., C.H.S.)
| | - Gregory J Stoddard
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City (S.H.M., A.K., G.J.S., C.H.S.)
| | - James C Fang
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
| | - Stavros G Drakos
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City (S.H.M., A.K., G.J.S., C.H.S.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
| | - Omar Wever-Pinzon
- Division of Cardiology, Department of Medicine (M.Y.Y., S.R., I.T., E.M.G., J.N.-N., J.S., G.J.S., J.C.F., S.G.D., O.W.-P.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT (S.H.M., E.M.G., J.N.-N., J.S., J.C.F., S.G.D., C.H.S., O.W.-P.)
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Voltolini A, Salvato G, Frigerio M, Cipriani M, Perna E, Pisu M, Mazza U. Psychological outcomes of left ventricular assist device long‐term treatment: A 2‐year follow‐up study. Artif Organs 2019; 44:67-71. [DOI: 10.1111/aor.13531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Alessandra Voltolini
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Gerardo Salvato
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
- Department of Brain and Brain and Behavioral Sciences University of Pavia Pavia Italy
- Cognitive Neuropsychology Centre ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
- NeuroMi Milan Center for Neuroscience Milan Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Manlio Cipriani
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Enrico Perna
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Mirella Pisu
- De Gasperis Cardio Center, 2nd Section of Cardiology, Heart Failure and Cardiac Transplant Unit ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
| | - Umberto Mazza
- Clinical Psychology, Department of Mental Health ASST “Grande Ospedale Metropolitano Niguarda” Milan Italy
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Tosto C, Adamo L, Craddock H, Di Blasi M, Girgenti R, Clemenza F, Carney RM, Ewald G. Relationship between device acceptance and patient-reported outcomes in Left Ventricular Assist Device (LVAD) recipients. Sci Rep 2019; 9:10778. [PMID: 31346241 PMCID: PMC6658659 DOI: 10.1038/s41598-019-47324-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
The number of Left Ventricular Assist Devices (LVADs) implanted each year is rising. Nevertheless, there are minimal data on device acceptance after LVAD implant, and on its relationship with patient-reported outcomes. We designed a cross-sectional study to address this knowledge gap and test the hypothesis that low device acceptance is associated with poorer quality of life, depression and anxiety. Self-report questionnaires were administered to assess quality of life (12-item Kansas City Cardiomyopathy Questionnaire quality of life subscale), level of anxiety (7-item Generalized Anxiety Disorder; GAD-7), level of depression (9-item Patient Health Questionnaire; PHQ-9) and device acceptance (Florida Patient Acceptance Survey; FPAS) to 101 consecutive patients presenting to LVAD clinic. Regression analysis showed a strong correlation between device acceptance and both psychological distress (p < 0.001) and quality of life (p < 0.001). Analysis of the sub-scales of the FPAS showed that patients had significant body image concerns, but return to function and device-related distress were the main drivers of the observed correlation between device acceptance and patient well-being. Younger age was associated with lower device acceptance (r = 0.36, p < 0.001) and lower quality of life (r = 0.54, p < 0.001). These findings suggest that interventions targeting device acceptance should be explored to improve outcomes in LVAD recipients.
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Affiliation(s)
- Crispino Tosto
- From the University of Palermo, Department of Psychological and Educational Sciences, Palermo, Italy
| | - Luigi Adamo
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Heidi Craddock
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Di Blasi
- From the University of Palermo, Department of Psychological and Educational Sciences, Palermo, Italy
| | | | | | - Robert M Carney
- From the Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Gregory Ewald
- From the Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Dunn JL, Nusem E, Straker K, Gregory S, Wrigley C. Human Factors and User Experience Issues with Ventricular Assist Device Wearable Components: A Systematic Review. Ann Biomed Eng 2019; 47:2431-2488. [PMID: 31342334 DOI: 10.1007/s10439-019-02303-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/07/2019] [Indexed: 01/24/2023]
Abstract
Ventricular Assist Devices (VADs) provide continuous mechanical circulatory support during in- and out-of-hospital care. However, limitations of the external wearable components influence patient quality of life. There is insufficient understanding of the issues with such components that combines a holistic viewpoint from both human factors and user (including patient and caregiver) experience perspectives. This paper comprehensively details the issues with VAD wearable systems and proposes a way for human-centered design to bridge the gap, addressing such issues synergistically. Through the review the authors investigated: the user issues caused by wearable components of VADs, and how human factors issues correlate to the VAD user experience. A Boolean search ("ventricular assist" AND "human factors" AND "experience") for peer-reviewed studies published between 2008 and 2018 returned 338 titles, with 35 relevant studies selected using a PRISMA process for inclusion in cross-study analysis and synthesis. This paper provides design recommendations for the issues found in the literature. Four key focus areas to inform the future design of VAD wearable components were identified-'Power Supply', 'Wearability and Travel Freedom', 'The Female Experience' and 'Intuitive Handling'. Using design to drive innovation could result in VAD wearable components which better meet or exceed users' quality of life goals.
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Affiliation(s)
- Jessica Lea Dunn
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia.
| | - Erez Nusem
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Karla Straker
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaun Gregory
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Cara Wrigley
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
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Tigges-Limmer K, Brocks Y, Winkler Y, Stock Gissendanner S, Morshuis M, Gummert JF. Mental health interventions during ventricular assist device therapy: a scoping review. Interact Cardiovasc Thorac Surg 2019; 27:958-964. [PMID: 29697790 DOI: 10.1093/icvts/ivy125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/21/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Because of the high prevalence of psychological disorders among ventricular assist device patients, mental health support is consensually recommended. No study as yet has provided an overview of recommended and reported mental health interventions. This article presents the results of a scoping review on these questions. METHODS We searched standard databases for relevant search criteria and found 4 consensus guidelines and 13 publications with original research mentioning mental health interventions for ventricular assist device patients. These publications are synthesized and augmented with practical recommendations from our reports and from a single-centre experience of others. RESULTS Consensus guidelines recommend mental health interventions in 4 areas: screening and diagnostics, assessment, support and treatment and education. Interventions vary across treatment phases and by device therapy strategy, as do typical sources of mental distress. A flow chart of interventions over the course of treatment summarizes these findings. CONCLUSIONS The delivery of consensually recommended mental health support for ventricular assist device patients involves the performance of multiple, complex tasks that vary across treatment phases. Mental health professionals should have specialized skills and should interact frequently with other caregivers in care teams.
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Affiliation(s)
- Katharina Tigges-Limmer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Yvonne Brocks
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Yvonne Winkler
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, University Clinic of the Ruhr University Bochum, Bad Oeynhausen, Germany
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Thohan V, Shi Y, Rappelt M, Yousefzai R, Sulemanjee NZ, Hastings TE, Cheema OM, Downey F, Crouch JD. The association between novel clinical factors and gastrointestinal bleeding among patients supported with continuous-flow left ventricular assist device therapy. J Card Surg 2019; 34:453-462. [PMID: 31058372 DOI: 10.1111/jocs.14062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study explores novel preimplantation risk factors associated with gastrointestinal bleeding (GIB) after continuous-flow left ventricular assist device (CF-LVAD) implantation. CF-LVAD therapy implantation for patients with advanced heart failure is associated with a 20% to 40% incidence of GIB. METHODS This study includes patients receiving CF-LVAD at a quaternary medical center from 2006 to 2014 (n = 254). The primary endpoint was GIB within 12 months after implantation; the secondary outcome was 3-year all-cause mortality. The Student t test or the χ2 test compared continuous or categorical variables. Competing risks analysis calculated the cumulative incidence of GIB postimplantation. Cox proportional hazards model was used for univariate/multivariate models predicting GIB. RESULTS Sixty-four patients had GIB, with incidence rates at 1, 3, and 12 months of 11.8%, 19.3%, and 25.2%, respectively. Endoscopy revealed no identified source of bleeding in 41%; 33% of lesions were localized in the upper gastrointestinal tract, with the bulk (39%) categorized as vascular. Patients with prior gastrointestinal abnormalities (n = 98) had a greater risk of GIB post-CF-LVAD (HR 1.85 [1.11-3.09]; P = 0.02) than those with normal gastrointestinal evaluation results (n = 45) and those without preimplantation gastrointestinal evaluation (n = 111). Baseline blood urea nitrogen, chronic obstructive pulmonary disease, and prior percutaneous coronary intervention were statistically associated with post-CF-LVAD GIB. The presence of GIB within 12 months of CF-LVAD implantation was associated with an increased risk of 3-year all-cause mortality (HR 2.57 [1.57-4.15]; P < 0.01). CONCLUSIONS First-year GIB is associated with increased mortality post-CF-LVAD. We advocate a closer examination of several GIB risk factors when evaluating CF-LVAD candidates.
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Affiliation(s)
- Vinay Thohan
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin
| | - Yang Shi
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin
| | - Matthew Rappelt
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora Research Institute, Aurora Health Care, Milwaukee, Wisconsin
| | - Rayan Yousefzai
- Department of Cardiology, Brown University, Providence, Rhode Island
| | - Nasir Z Sulemanjee
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin
| | - Thomas E Hastings
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin
| | - Omar M Cheema
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin
| | - Frank Downey
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin
| | - John D Crouch
- Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin
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Kugler C, Meng M, Rehn E, Morshuis M, Gummert JF, Tigges-Limmer K. Sexual activity in patients with left ventricular assist devices and their partners: impact of the device on quality of life, anxiety and depression. Eur J Cardiothorac Surg 2019; 53:799-806. [PMID: 29211843 DOI: 10.1093/ejcts/ezx426] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Prolonged support with a left ventricular assist device (LVAD) has evolved as an alternative treatment strategy for patients with end-stage heart disease. This requires a shift in focus on sexual activity and psychosocial outcomes in patients with an LVAD and their partners. METHODS This cross-sectional study was designed to capture Sexual Activities in Left Ventricular Assist Device Patients Or PaRtners (SALVADOR) perceptions on illness-related changes in the quality of sexual activity and its impact on quality of life, anxiety and depression using standardized patient-reported outcome scales (Sexual Adjustment Scale, 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale). A total of 72 patients with LVADs (50% response rate) along with 48 partners participated. RESULTS For patients with an LVAD (median age 60 years; 84.7% male), median time on the device was 650 days; 69.5% stayed in long-term partnerships (median 23 years). Prevalence rates for illness-related changes in the quality of sexual activity were 58.3% for patients and 52.1% for partners. Device-related disturbances in sexual activities occurred due to battery pockets (patients/partners: 59.2%/37.6%; P = 0.006) and the driveline (46.3%/37.5%; P = 0.033) and led to significantly increased distress in patients/partners (battery pockets: 53.5%/41.3%; P = 0.006; driveline 54.9%/37.5%; P = 0.004). Disturbances in sexual activity were independently associated with higher rates of depression (odds ratio 1.33, 95% confidence interval 1.14-1.55; P = 0.001) in patients and lower mental quality of life (odds ratio 6.18, 95% confidence interval 1.13-33.98; P = 0.036) in partners. CONCLUSIONS Disturbances in sexual activity are common in patients with an LVAD and their partners while the patients are on durable long-term support. Counselling on long-term adjustment should provide a platform for information seeking on illness-related changes in the quality of sexual activity.
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Affiliation(s)
- Christiane Kugler
- Faculty of Medicine, Nursing Science, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Michael Meng
- Faculty of Medicine, Nursing Science, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Erik Rehn
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
| | - Katharina Tigges-Limmer
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia Bad Oeynhausen, Ruhr-University of Bochum, Bochum, Germany
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Genev I, Yost G, Gregory M, Gomez K, Pappas P, Tatooles A, Bhat G. Improved Nutrition Status in Patients With Advanced Heart Failure Implanted With a Left Ventricular Assist Device. Nutr Clin Pract 2019; 34:444-449. [DOI: 10.1002/ncp.10238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ivo Genev
- Department of Medicine; University of Illinois College of Medicine; Chicago Illinois USA
| | - Gardner Yost
- Department of Medicine; University of Illinois College of Medicine; Chicago Illinois USA
- Center for Heart Transplant and Assist Devices; Advocate Christ Medical Center; Oak Lawn Illinois USA
| | - Mary Gregory
- Department of Clinical Nutrition; Advocate Christ Medical Center; Oak Lawn Illinois USA
| | - Kayéromi Gomez
- the Office of Research; Department of Biostatistics; University of Illinois College of Medicine; Rockford Illinois USA
| | - Patroklos Pappas
- Department of Clinical Nutrition; Advocate Christ Medical Center; Oak Lawn Illinois USA
| | - Antone Tatooles
- Center for Heart Transplant and Assist Devices; Advocate Christ Medical Center; Oak Lawn Illinois USA
| | - Geetha Bhat
- Center for Heart Transplant and Assist Devices; Advocate Christ Medical Center; Oak Lawn Illinois USA
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Schmidt T, Bjarnason-Wehrens B, Mommertz S, Schulte-Eistrup S, Willemsen D, Sindermann J, Predel HG, Reiss N. Development of exercise-related values in heart failure patients supported with a left ventricular assist device. Int J Artif Organs 2018; 42:201-206. [DOI: 10.1177/0391398818815492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Following implantation of a left ventricular assist device, the build-up and long-term maintenance of adequate exercise capacity and functional performance become crucial. The aim of this study was to observe the development of exercise-related values at different times, as well as to detect possible influencing factors. We performed a prospective single-centre study: 10 patients (63 years, 100% male, body mass index = 27.5, 100% HeartWare) underwent the following diagnostic tests during cardiac rehabilitation and during two subsequent ambulatory visits: 6-min walking test, handgrip strength test, cardiopulmonary exercise test and Minnesota Living with Heart Failure questionnaire. Mean follow-up was 482 days after left ventricular assist device implantation. Significant improvements could be observed between the end of cardiac rehabilitation and ambulatory visit 1; 6-min walking distance increased from 367 to 449 m (p < 0.01), peak VO2 from 10.0 to 11.9 mL/kg/min (p < 0.05) and peak load from 62.4 to 83.0 W (p < 0.01). However, there were no further improvements between ambulatory visit 1 and ambulatory visit 2. In the long term, a significant mean weight gain of more than 10 kg could be observed (p < 0.01). A negative linear correlation between weight gain and absolute improvement in peak load (r = −0.77, p < 0.01) and peak VO2 (r = −0.75, p < 0.05) could be demonstrated. In conclusion, exercise-related values following left ventricular assist device implantation initially improve significantly. Later, however, no further improvements can be observed. In the long term, pronounced weight gain is conspicuous, concomitant with a significantly lower increase in exercise values of the patients. In the future, both dietary and structured physical activity follow-up interventions should be integrated in patient routines.
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Affiliation(s)
- Thomas Schmidt
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | | | | | | | | | - Hans-Georg Predel
- Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Nils Reiss
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
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46
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Ambulatory Ventricular Assist Device Patient Management. Cardiol Clin 2018; 36:571-581. [PMID: 30297074 DOI: 10.1016/j.ccl.2018.06.014] [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] [Indexed: 11/24/2022]
Abstract
Understanding the ventricular assist device (VAD) patient pump interface and developing expertise in monitoring patients with a VAD are the goals of care in the ambulatory setting. The objective is to improve long-term outcomes. The purpose of expert, focused, routine outpatient surveillance is to facilitate the integration of pulseless, electrically dependent VAD patients into the community. Other goals of outpatient care include maximizing quality of life, maintaining equipment integrity, treating heart failure symptoms, monitoring for common VAD-related complications, ensuring viability as a heart transplant candidate, consideration for patients implanted to become transplantable, and monitoring for possible cardiac recovery.
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Voruganti DC, Briasoulis A, Chaudhry M, Alvarez P, Cotarlan V, Bhama JK, Giudici M. Cardiac resynchronization therapy and outcomes in patients with left ventricular assist devices: a systematic review and meta-analysis. Heart Fail Rev 2018; 24:229-236. [DOI: 10.1007/s10741-018-9740-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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49
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The Relationship of Anxiety, Depression, and Quality of Life in Adults With Left Ventricular Assist Devices. ASAIO J 2018; 64:515-520. [DOI: 10.1097/mat.0000000000000681] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Desai SR, Hwang NC. Advances in Left Ventricular Assist Devices and Mechanical Circulatory Support. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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