Clinical Outcomes in Patients Who Live Alone After Undergoing HeartMate III Implantation

Abstract

<h3>Purpose</h3> Left ventricular assist devices (LVAD) are used to treat patients with end-stage heart failure. Historically, the first and second generation LVADs required significant social support due to high incidence of pump thrombosis and other complications. HeartMate III is a third generation LVAD device associated with lower complication rates. This study was aimed at assessing the effect of living alone on survival and complication in patients with LVAD. <h3>Methods</h3> This was a single center retrospective observational study including patients from the Deborah Heart and Lung Center in New Jersey who underwent LVAD implantation between 2018 and 2021. We assessed the association between living arrangement and the rate of complications including gastrointestinal bleeding, pump thrombosis, stroke, driveline infections, and overall survival, using univariate and multivariate regression analyses. <h3>Results</h3> A total of 52 patients were included in this study (age 64.5±12.7 years, 81% male, 73% white, and 40% lived alone) with an average follow-up duration of 372±328 days from LVAD implantation. Mortality rate was significantly lower in those who lived alone vs not-alone (2/21 vs. 13/31, P=0.004) (Figure 1). This relationship persisted after correcting for possible confounders including age and comorbidities (HR_Adj=11, P=0.046). In addition, multivariate analysis showed no statistically significant difference in gastrointestinal bleeding, stroke, driveline infection, or pump thrombosis (Figure 1). <h3>Conclusion</h3> Our data suggests that living alone is not associated with increased mortality in post-LVAD patients when compared to those not living alone. In fact, living alone portended better survival and should not necessarily preclude LVAD consideration. Future research, including randomized controlled trials, is needed to confirm and explain these findings.