Association of Patient Health Outcomes with Caregiver Burden after LVAD in Destination Therapy and as a Bridge to Transplant

Abstract

<h3>Purpose</h3> While left ventricular assist devices (LVADs) are known to improve heart failure (HF) patient survival and health status (i.e., symptoms, function, and quality of life), they also require substantial support from caregivers (CG). In fact, excessive CG burden is a relative contraindication to LVAD implantation. Importantly, CG burden can be a transient state and whether or not this improves in patients' whose health status improves from before to after LVAD implantation has not been described. <h3>Methods</h3> Between 10/1/15 and 12/31/18, 96 patients and their CGs were recruited from 13 U.S. sites; data through 1 year after LVAD implantation were used. Patient health status was defined by Kansas City Cardiomyopathy Questionnaire-12 (KCCQ) Overall Summary score, where higher scores indicate better health status. 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), respectively. Linear regression was used to identify patient and CG factors independently associated with change in CG burden. <h3>Results</h3> LVAD recipients were 67.5±5.4 years old, 86% male, and with an implant strategy of destination therapy (65%) and bridge to transplant (35%). Their baseline KCCQ score was 45.5±23.9. Their CGs were 60.7±10.3 years old, 91% female and had baseline OCBS time and burden scores of 2.4±0.7 and 1.4±0.5, respectively. Better baseline and greater improvements in patients' health status was strongly associated with improvements in CG burden, both time and difficulty (Table). <h3>Conclusion</h3> This study highlights the complex dyadic relationship between HF patients and their CGs. After LVAD implantation, the greater the improvement in HF patient health status, the greater the reduction in CG burden. The likelihood of patient improvement with LVAD implantation should be considered when there is concern about CG burden prior to implantation.