Predictors of changes in health status between and within patients 12 months post left ventricular assist device implantation

Abstract

Background Improving patient‐reported outcomes (e.g. health status) has become an important goal in left ventricular assist device (LVAD) therapy, in addition to reducing mortality and morbidity. We examined predictors of changes in health status scores between and within patients 12 months post LVAD implantation. Methods Health status [Kansas City Cardiomyopathy Questionnaire (KCCQ); Short‐Form 12 (SF‐12)] were assessed at 3–4 weeks after implantation, and at 3, 6 and 12 months follow up in 54 LVAD patients (74% men; mean age 54 ± 9 years). Results Patients experienced significant improvements in health status between baseline and 3 months follow‐up as assessed by the KCCQ (clinical summary score: F = 33.49, P < 0.001; overall summary score: F = 31.13, P < 0.001) and the SF‐12 (physical component score: F = 31.59, P < 0.001; mental component score: F = 21.77, P < 0.001), but not between 3 months and 12 months follow‐up (P > 0.05 for all). Higher scores on anxiety and depression over time, older age, lower ejection fraction, and more co‐morbidity were associated with poorer health status scores on one or both of the KCCQ and SF‐12 subscales. The majority of the between‐patient variance of the mental component summary scores (82.6%), but not the KCCQ overall summary score (41.9%), KCCQ clinical summary score (36.2%) and physical component summary scores (23.2%), was explained by the sociodemographic, clinical and psychological factors. Conclusion The majority of LVAD patients show a significant improvement in health status after LVAD implantation. However, there are large differences in individual health status score trajectories which are only partly explained by measures of disease severity pre‐LVAD, co‐morbidity and psychological stress.

Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device

“…Prior studies have shown limited associations between psychological distress and QOL, 1,7 suggesting that factors other than psychological problems may be important in determining QOL after LVAD implantation.…”

“…The purpose of the present study was (1) to evaluate the effect of an having an implantable LVAD on patients' QOL, eft ventricular assist device (LVAD) therapy is expected to be increasingly indicated as a bridge to transplant or/and destination therapy. However, studies focusing on the effect of LVAD therapy on patients' quality of life (QOL) are limited.…”

“…However, studies focusing on the effect of LVAD therapy on patients' quality of life (QOL) are limited. [1][2][3] In Japan, the number of LVAD patients has been increasing since implantation became covered by health insurance in 2011. It is important to know the effect of LVAD therapy from the patients' perspective.…”

Anxiety and Depression in Cardiovascular Surgery

“…After Brouwer's study, some studies [28,29] found decreasing of anxiety/depression after introducing LVADs, but two studies [30,31], whose sample size were about 10, did not found the significant improvement in anxiety and depression. Higher scores on anxiety/ depression over time were associated with poor health status [32] and rehospitalization [33]. Family of patients with LVAD was also increasing anxiety or depression level after implantation [34,35].…”

Possibilities of Anxiety-Depressive Disorders Treatment in Patients With Chronic Heart Failure

“…По данным Всемирной организации здра-воохранения (ВОЗ), тревога и депрессия приводят к снижению когнитивных функций. Помимо этого, известно, что у больных с сердечно-сосудистой пато-логией, особенно при ХСН, возрастает риск развития цереброваскулярной патологии, при которой снижа-ется функциональная активность центральной нерв-ной системы (ЦНС) в связи с нарушением микроцир-куляции в тканях мозга, что может проявляться не только снижением когнитивных функций, но и нарушением вегетативного баланса [10][11][12], который, в свою очередь, нарушается и на органном уровне при ишемии миокарда [13,14].…”