Postdischarge Functional Capacity, Health-Related Quality of Life, Depression, Anxiety, and Post-traumatic Stress Disorder in Patients Receiving a Long-term Left Ventricular Assist Device
Graphical Abstract
Visual Take Home Graphic (for Health Care Professionals); GAD-7, Generalized Anxiety Disorder (7 item); IES-R, Impact of Event Scale (Revised); LVAD, left ventricular assist device; PHQ-9, Patient Health Questionnaire (9 item); PTSD, post-traumatic stress disorder.; Key to Health-Related Quality of Life (EQ-5D) problem scores: blue, none; green, mild; orange, moderate; red, severe; purple, extreme.
Section snippets
LAY SUMMARY
We investigated the quality of life of 121 patients in the United States and Australia who were living at home with a left ventricular assist device (LVAD). Patients readily accepted the questionnaires and about two-thirds responded that they were doing well. A third reported impaired function and quality of life with moderate to severe depression (including suicidal ideation), anxiety and post-traumatic stress disorder. Incorporating these questionnaires into standard care before implantation
BULLET POINTS
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Most left ventricular assist device patients at home are satisfied with their functional capacity and quality of life.
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Some left ventricular assist device patients suffer from severe depression, anxiety, and post-traumatic stress disorder.
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Left ventricular assist device patients may benefit from psychological evaluation and support before and after device implantation.
Heart failure is commonly associated with functional impairment, poor health-related quality of life (HR-QOL) and depression.1,2 A
Methods
This prospective dual-center cross-sectional study included adult patients (>18 years) with heart failure at least 30 days after discharge after index implantation of a long-term continuous flow LVAD, designed in compliance with STROBE Guidelines.6 Participants were sampled from patients with chronic heart failure managed at New York Presbyterian Hospital Columbia University Irving Medical Center in New York, and The Alfred Hospital in Melbourne, Australia. Human research institutional review
Demographic Data
Of the 129 eligible patients, 5 declined to consent, 3 later declined to participate, and 1 discontinued part way through the interview; 121 patients (94%) consented and were assessed during on-site clinic visits or by telephonic follow-up at home (Fig. 1).
At the end of the interview, 18 patients (15%) requested a referral to mental health services. Demographic data are summarized in Table 2. The mean patient age at enrollment was 57.5 ± 15.2 years, ranging from 19 to 84 years, with a
Discussion
In this 2-center study of 121 patients at varying durations after LVAD implantation, we found that patient-centered health scales administered via a clinic or telephonic interview are feasible and well-accepted and also revealed some serious health issues that might otherwise have been missed. Although a majority of LVAD outpatients reported good functional capacity and psychologic status, 15%–35% reported moderate to severe disability, HR-QOL issues, depression, anxiety, and symptoms of PTSD.
Strengths and Limitations
The strengths of this study are that data were collected at 2 major heart failure centers on different continents with patient demographics and device type and strategy consistent with many other centers. In addition to patient-reported functional disability and HR-QOL, it provides hypothesis-generating information on depression, anxiety and PTSD in LVAD patients that could guide further research on the prophylaxis, early diagnosis, and therapy of these important psychological challenges.
We
Conclusions
We found that patient-centered health scales are readily accepted by LVAD patients and warrant integration into standard peri-implantation protocols. A majority of our discharged LVAD patients were doing well, but 15%–35% reported moderate to severe levels of disability, HR-QOL problems, depression, and anxiety. A small but important subset of patients exhibited suicidal ideation and concerning symptoms of PTSD that had not been recognized previously. During evaluation for LVAD implantation,
Sources of Funding
None.
Financial Conflict of Interest
D.M. and Y.N. report consultant fees from Abbott; P.C.C. receives research fees from Abbott. The other authors have no relevant relationships to disclose.
Author Contributions
Conception and design of work: R.N.S., M.A.S., C.H., P.S.M., M.Y., P.C.C.
Data collection: A.M.A., J.H., M.A.S.
Data analysis and interpretation: A.J., R.N.S., M.A.S., C.H.
Drafting the manuscript: R.N.S., M.A.S., C.H., P.S.M.
Critical analysis: R.N.S., M.A.S, C.H., P.S.M., D.M., S.N., M.Y., P.C.C.
Final approval: R.N.S., M.A.S, A.J, C.H., P.S.M., D.M., S.N., A.M.A., J.H., K.T., Y.N., H.T., P.B., M.B., M.Y., P.C.C.
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This work was performed at Columbia University Irving Medical Center, New York, NY 10032, USA, and The Alfred Hospital, Melbourne VIC 3004, Australia.