Quality of Life and Emotional Distress Early After Left Ventricular Assist Device Implant: A Mixed-Method Study

Abstract

Patients who temporarily or permanently rely on left ventricular assist devices (LVADs) for end-stage heart failure face complex psychological, emotional, and relational problems. We conducted a mixed-method study to investigate quality of life, psychological symptoms, and emotional and cognitive reactions after LVAD implant. Twenty-six patients admitted to cardiac rehabilitation were administered quality of life questionnaires (Short Form 36 of the Medical Outcomes Study and Minnesota Living with Heart Failure Questionnaire), the Hospital Anxiety and Depression Scale, and the Coping Orientation for Problem Experiences inventory, and underwent three in-depth unstructured interviews within 2 months after LVAD implant. Quality of life assessment (Short Form 36) documented persistently low physical scores whereas mental component scores almost achieved normative values. Clinically relevant depression and anxiety were observed in 18 and 18% of patients, respectively; avoidant coping scores correlated significantly with both depression and anxiety (Pearson correlation coefficients 0.732, P < 0.001 and 0.764, P < 0.001, respectively). From qualitative interviews, factors that impacted on LVAD acceptance included: device type, disease experience during transplant waiting, nature of the assisted organ, quality of patient-doctor communication, the opportunity of sharing the experience, and recipient's psychological characteristics. Quality of life improves early after LVAD implant, but emotional distress may remain high. A multidimensional approach that takes into account patients' psychological characteristics should be pursued to enhance LVAD acceptance.

The Relationship Between Psychological Symptoms and Ventricular Assist Device Implantation

“…Previous studies examining depression in patients with VADs have been cross-sectional 8–10 , or have included infrequent follow up over about 6–15 months 11, 12 . Mapelli and Modica’s studies demonstrated that after VAD implantation, patients experienced mild anxiety or depression without significant changes over time.…”

“…This is an important topic to examine as heart failure itself can have an effect on psychiatric health, in particular depression. 7 The literature on psychological symptoms in patients with VADs is restricted to depression, anxiety 8–12 , and post-traumatic stress disorder (PTSD), and the majority of these studies included only a small number of patients (e.g. a range of 14–30 patients).…”

Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

“…25 Similar findings are reported in a mixed methods study in which improved quality of life was reported early after implantation but emotional distress remained high. 26 It should be noted that the current body of knowledge related to quality of life and emotional distress in the post implantation period remains limited. Additional studies addressing quality of life over time capturing individual change are needed including both general quality of life measures such as the European Quality of Life-5 Dimensions (EQ5D) and measures specific and sensitive to the LVAD population such as mixed methods and qualitative studies.…”

Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care

“…In order to make the interpretation of the two MLHFQ dimensions comparable, the physical and emotional dimension scores were standardized to 0-100 and reversed with higher scores indicating better quality of life. The MLHFQ is widely used in Italian studies (Giordano et al, 2013;Modica et al, 2015) and its validity and reliability has been established (Garin et al, 2013;Munyombwe et al, 2014). Reliability of the MLHFQ in this study resulted with a Cronbach's alpha of 0.89 for the physical dimension, 0.86 for the emotional dimension and 0.92 for the whole instrument.…”