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

https://doi.org/10.1016/j.cardfail.2021.07.019Get rights and content

Highlights

  • A left ventricular assist device does not preclude disability or impaired life quality.

  • Patient-centered questionnaires are well-accepted and revealing.

  • Some patients have severe depression with suicidal ideation.

  • Some patients have severe anxiety and post-traumatic stress disorder.

  • Psychological evaluation and support are warranted before and after implantation.

Abstract

Background

There is a paucity of data on depression, anxiety and post-traumatic stress disorder after left ventricular assist device (LVAD) implantation. We designed an observational study to integrate these with functional capacity and health-related quality of life (HR-QOL) in surviving LVAD patients.

Methods and Results

Consenting patients between 1 month and 9 years after LVAD implantation (n = 121) were screened for functional capacity (World Health Organization Disability Assessment Schedule 2.0 [WHODAS 2.0)]); HR-QOL (European Quality of Life [EQ-5D] and Visual Assessment Scales [EQ-VAS]), depression (Patient Health Questionnaire [PHQ-9], anxiety (Generalized Anxiety Disorder Scale [GAD-7]) and post-traumatic stress disorder (Impact of Event Scale Revised [IES-R]). Of the 94% of patients who consented, 34.7% reported impaired functional capacity (WHODAS 2.0 score of ≥25%), 23.1%–34.7% HR-QOL problems (domain EQ-5D of ≥3), 10.7% “poor health” (EQ-VAS of ≤40), 14.9% depression (PHQ-9 of >14), 11.7% suicidal ideation and 17.5% anxiety (GAD-7 of >10). Among these patients, 23.5% had a positive screen for post-traumatic stress disorder (IES-R of ≥24). An EQ-VAS of 80 or greater predicted good functional capacity (P < .001).

Conclusions

One-third of discharged LVAD patients reported impaired function, HR-QOL, and psychological issues. A standardized evaluation before and after LVAD implantation could facilitate psychologic prehabilitation, inform decision-making, and identify indications for mental health intervention.

Graphical Abstract

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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

  • Most left ventricular assist device patients at home are satisfied with their functional capacity and quality of life.

  • Some left ventricular assist device patients suffer from severe depression, anxiety, and post-traumatic stress disorder.

  • 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.

References (29)

  • D Revicki et al.

    Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes

    J Clin Epidemiol

    (2008)
  • AM Higgins et al.

    The psychometric properties and minimally clinically important difference for disability assessment using WHODAS 2.0 in critically ill patients

    Crit Care Resusc

    (2021)
  • HJ Warraich et al.

    Physical function, frailty, cognition, depression, and quality of life in hospitalized adults ≥60 years with acute decompensated heart failure with preserved versus reduced ejection fraction

    Circ Heart Fail

    (2018)
  • R Ahmed et al.

    Surgery for heart failure: treatment options and implications

    J Card Surg

    (2021)
  • Cited by (0)

    This work was performed at Columbia University Irving Medical Center, New York, NY 10032, USA, and The Alfred Hospital, Melbourne VIC 3004, Australia.

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