Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy

Abstract

BackgroundAlthough current guidelines emphasize the importance of social support to the success of left ventricular assist device (LVAD) therapy, few studies examine the influence of the caregiver on patient outcomes or quantify the impact of LVAD caregiving on caregiver outcomes. The purpose of this analysis was to identify patient and caregiver determinants of patient quality of life (QOL) and caregiver strain in response to LVAD therapy.Methods and ResultsData on patients receiving LVAD therapy and their caregivers (n=50 dyads) were prospectively collected pre‐implantation and 1, 3, and 6 months post‐implantation. Growth curve modeling was used to describe change in patient QOL (Kansas City Cardiomyopathy Questionnaire) and caregiver strain (Multidimensional Caregiver Strain Index). Patient QOL improved most in the first month (β=23.22±3.76, P<0.001), followed by gradual gains over 6 months (β=1.90±0.64, P<0.01). Caregivers experienced worsening of strain in the first month (β=4.30±1.42, P<0.01), followed by gradual resolution to pre‐implantation levels by 6 months (β=−0.71±0.23, P<0.01). Worse pre‐implantation patient symptoms were associated with greater improvement in patient QOL (β=0.53±0.19, P<0.01) but worsening caregiver strain (β=0.15±0.07, P=0.04). Better relationship quality was associated with greater improvement in patient QOL (β=14.39±5.85, P=0.01) and less pre‐implantation caregiver strain (β=−9.31±2.28, P<0.001). Nonspousal caregivers experienced less pre‐implantation strain (β=−8.60±3.10, P=0.01), and patients with nonspousal caregivers had less improvement in QOL (β=−3.70±1.62, P=0.02).ConclusionsA combination of patient and caregiver characteristics predicts patient and caregiver response to LVAD therapy. Including caregiver factors in future studies may be helpful in developing interventions that improve patient and caregiver outcomes, together.

Correlation between quality of life of cardiac patients and caregiver burden

“…This result is consistent with other studies, especially in Asian countries that have similar norms [10]. Another study found that not only the type of the relationship but also its quality affects the caregiver's level of strain [23].…”

“…The novel aspect of this study is the relationship between cardiac patients' QoL and the caregiver burden due to the limited number of studies on this subject. It is noteworthy that the PLOS ONE burden increased when the patients' QoL increased; this is consistent with the study by Bidwell et al [23] in which they found that when the QoL of cardiac patients improved at one month post discharge after left ventricular assist device therapy, the caregiver burden was the highest. The same result was found in the meta-analysis study by Bidwell et al [34], which observed that improving the QoL of cardiac patients led to more physical and emotional strain on their caregivers and more time spent providing care for which they were unprepared, especially as most of them were young, female, and uneducated.…”

Exploring illness denial of LVAD patients in cardiac rehabilitation and their caregivers: A preliminary study

“…In brief, despite the improvements in emotional health, the illness denial defense mechanism increased when approaching discharge to home. This is not surprising considering that returning home may represent a threatening phase requiring to assume stronger personal responsibilities in order to manage the device and the several related lifestyle changes …”

“…In the last two decades, the left ventricular assistance device (LVAD), a modern electromedical circulatory used in patients with advanced heart failure, dramatically changed the life‐conditions of an increasing number of patients and consequently of their caregivers . In fact, the implanted device may have a significant impact on patients’ and caregivers’ lives, sometimes requiring them to cope with several adaptation challenges . The presence of emotional distress and psychological issues have been identified, providing evidence that these aspects need to be assessed for patients and caregivers .…”

“…In fact, the implanted device may have a significant impact on patients’ and caregivers’ lives, sometimes requiring them to cope with several adaptation challenges . The presence of emotional distress and psychological issues have been identified, providing evidence that these aspects need to be assessed for patients and caregivers . This is particularly true for patients in destination therapy .…”