Association Between Caregiver Burden and Patient Recovery After Left Ventricular Assist Device: Insights from Sustain-it

Abstract

Introduction: While health-related quality of life (HRQOL) for patients with advanced heart failure is improved after left ventricular assist device (LVAD) implantation, caregivers (CGs) may experience worse quality of life due to new roles and responsibilities. CG burden is associated with worse outcomes in patients with other chronic illnesses, but the association between caregiver burden and patient recovery following LVAD implant for destination therapy (DT) has not been described. Methods: Between 10/1/15 and 12/31/18, 154 DT LVAD patients (age=60-80 years) and 108 DT CGs from 13 U.S. sites were enrolled. Of these, data through 1 post-operative year from 64 patients and CGs were analyzed. CG burden was measured using the Oberst Caregiver Burden Scale (OCBS): 15 items (range=1-5), measuring perceived amount of time spent and difficulty of tasks (higher score=more time on task and more difficulty of task), respectively. High CG burden=scoring greater than the cohort median. Patient recovery post-LVAD implant was defined by change in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), change in 6-minute walk distance (6MWD), and re-hospitalizations over 1 year. Proportional odds models for change in KCCQ-12 and 6MWD and linear regression for re-hospitalizations were used to assess for an association with CG burden. Results: Patients were 69.4±5.4 years, 86% male, and 91% White. Over the first year post-LVAD implant, 30% were hospitalized, 73% (47/64) had an improvement of at least 5 points on KCCQ-12 scores and 16% (10/64) a deterioration of at least 5 points. Mean 6MWD was 206.7 (SD, 133.9) meters at baseline and improved to 280.5 (SD, 102.5) meters at 1 year. CGs were 61.7±11.3 years, 94% female, 82% White, and 86% married. Median OCBS-difficulty score at baseline was 1.20 and median for time was 2.27. Higher CG burden was not associated with hospitalizations or changes in patient HRQOL or 6MWD over the first year following LVAD implant (table). Discussion: Higher CG burden at baseline was not associated with patient recovery in the first year post-LVAD implant. Understanding how CG burden is associated with patient outcomes following LVAD implant is important as lack of CG support is typically a contraindication for LVAD implantation.