Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy

Bidwell, Julie T.; Lyons, Karen S.; Mudd, James O.; Gelow, Jill M.; Chien, Christopher; Hiatt, Shirin O.; Grady, Kathleen L.; Lee, Christopher S.

doi:10.1097/jcn.0000000000000378

Cited by 53 publications

(63 citation statements)

References 45 publications

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“…This was a prospective longitudinal study of patients receiving an LVAD and their caregivers (n=50 dyads, where each dyad consists of a patient and associated caregiver). 14,15 Because little research has been done to examine patient-caregiver dyads in LVAD therapy, no formal sample size calculation based on expected effect sizes was conducted; rather, sample size was primarily determined by the number of patients and caregivers it was feasible to enroll during the funding period on the basis of center implantation rates. In short, patients were eligible for enrollment if they were ≥21 years of age, eligible to receive an LVAD, and without previous heart transplantation.…”

Section: Study Design and Populationmentioning

confidence: 99%

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

Bidwell

Lyons

Mudd

et al. 2018

JAHA

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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.

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Section: Study Design and Populationmentioning

confidence: 99%

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

Bidwell

Lyons

Mudd

et al. 2018

JAHA

Self Cite

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“…Perhaps more significant is the inverse relationship between context (e.g., anxiety) and distal outcome (QOL) dimensions. This finding can be explained by the fact that anxiety and depression are highly prevalent in the LVAD population (29,30). As shown in Table 3, our study patients' anxiety and depression scores were slightly worse than the average score of U.S. adults living with the same condition (anxiety and depression; (18)).…”

Section: Discussionmentioning

confidence: 57%

“…As shown in Table 3, our study patients' anxiety and depression scores were slightly worse than the average score of U.S. adults living with the same condition (anxiety and depression; (18)). Remarkably, the coexistence of anxiety and depression, and associated negative influences on QOL, are commonly reported in heart failure studies and from data derived from the LVAD population (29)(30)(31).…”

Section: Discussionmentioning

confidence: 94%

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Advancing the Science of Self‐Management in Adults With Long‐Term Left Ventricular Assist Devices

Casida

Aikens

Pagani³

et al. 2018

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This study tested the applicability of the individual and family self-management theory (IFSMT) to self-management (SM) in patients with left ventricular assist devices (LVADs). From an existing data set, we extracted the following variables that correspond to IFSMT's conceptual dimensions: anxiety, depression, and cognition (context dimension); self-efficacy (SM process dimension); adherence and quality of life (QOL; outcome dimensions). Descriptive statistics and partial least squares path modeling procedures were used for data analyses. A total of 100 patients (mean age 52 ± 13.4 years) with continuous flow LVAD designs comprised the present study. Most patients were White (78%), married (69%), college-educated (72%), and on disability (53%). Their mean anxiety and depression scores were slightly above normal, while their cognitive function scores were slightly lower than normal. LVAD care self-efficacy, adherence, and QOL were within normal ranges. Factor loadings ranged from 0.50 to 1.0, and there were significant forward path relationships among the context, process, and outcome dimensions (β ranges from 0.02 to 0.60, all P values < 0.05). In conclusion, the IFSMT provides a good fit for SM in LVAD. Further research is needed to clarify how best to improve LVAD SM practice and treatment outcomes.

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“…patients with a diagnosis of depression and of both depression and anxiety (9). Caregivers, on their part, are constantly exposed to psychological burden and it is known that their emotional distress can influence patients themselves (6,7). Bruce et al (10) demonstrated that the presence of prepared and efficient caregivers significantly reduces the risk of mortality in LVAD patients.…”

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confidence: 99%

Does a Comprehensive Inpatient Rehabilitation Program Improve Patients’ and Caregivers’ Emotional State in LVAD Patients?

Ferrario

Bacich²,

Beltrame³

et al. 2018

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Few studies evaluated the effect of cardiac rehabilitation programs on perceived emotional and health status of left ventricular assist device (LVAD) patients, and none explored their effect on caregivers' strain. We enrolled 119 adult LVAD patients, together with their caregivers (n = 91), in two Rehabilitation Institutes that provided inpatient multidisciplinary activities. At admittance and prior to discharge they completed questionnaires evaluating patient emotional state and subjective perception of health status, caregiver strain, and patient and caregiver perception of the VAD. Six months after discharge, patients and caregivers were contacted again and asked specific questions about their quality of life. Patients' state anxiety and depression symptoms significantly diminished at discharge (0.000), whereas their perception of general health status rose (0.000). Caregivers' perceived strain also significantly decreased (0.001) and the perceived device management skill grew both for patients and caregivers (0.000). A substantial amount (36%) of psychologically frail patients and caregivers, although improving their emotional condition, never reached that of the less frail subjects. At the 6-month follow-up, both patients and caregivers appeared stable in evaluating respectively their general health and their caregiving-related strain, compared to discharge. Our data show that a comprehensive inpatient rehabilitation program improves the emotional state of LVAD patients and of their caregivers, even in psychologically frailer subjects. Team approach makes patients and caregivers self-confident about device management, increasing their knowledge, clarifying their doubts, and encouraging them to handle the difficulties met during the rehabilitation period, suggesting strategies to cope with daily life at home.

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Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy

Cited by 53 publications

References 45 publications

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

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

Advancing the Science of Self‐Management in Adults With Long‐Term Left Ventricular Assist Devices

Does a Comprehensive Inpatient Rehabilitation Program Improve Patients’ and Caregivers’ Emotional State in LVAD Patients?

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