LVAD Strategy Reflects Emotional Functioning after Implant

Abstract

Purpose With an increased prevalence of anxiety and depression in advanced heart failure, left ventricular assist device (LVAD) implantation has recently been shown to mitigate some of these mental health issues by improved functional capacity and quality of life (QOL). There is mixed data available regarding LVAD strategy, so our aim was to compare emotional wellbeing between destination therapy (DT) and bridge to transplant (BTT) post LVAD based on existing QOL tools and preliminary data from a new tool, Quality of Life with a Left Ventricular Assist Device (QOLVAD). Methods LVAD strategy was identified on initial questionnaire as BTT, DT, Bridge to Decision, and other. A new validation tool currently being tested at our consortium (QOLVAD) consisting of 10 items in the emotional subset (score 0-100, higher better), was compared with other well-established measures of QOL; Patient Health Questionnaire (PHQ-9, score 0-27, higher worse), Patient Reported Outcomes Measurement Information System (PROMIS, score 40.3-81.6, higher worse), and Euroqol 5 dimensions (EQ-5D, score 0-100, higher better). Surveys were completed at a median time of 44 weeks after implantation. Results Preliminary findings from the 186 LVAD patients enrolled across seven centers participating in evaluation of the QOLVAD tool included 50% BTT (n=87) and 30.1% DT (n=53). There was no statistical difference in emotional domain (p=0.11). Interestingly, social functioning was higher in DT vs. BTT (p=0.04) which might suggest patients that are more socially content function better emotionally. There was no statistical significance in PHQ-9 scores between DT and BTT (p=0.43). There was less anxiety and better emotional scoring in DT patients vs BTT in PROMIS scores which was statistically significant (p=0.03). Conclusion Recent observations suggest that social functioning, such as return to work and intimacy (physical and emotional) can affect emotional status. Furthermore, literature suggest that VAD implantation partially alleviates depression and anxiety but LVAD patients continue to experience this more than heart transplant recipients. Studies also demonstrate BTT patients have increased anxiety in anticipation of a life-altering event compared to either post-transplant or other LVAD patients which is supported by our findings. This illustrates the need for more aggressive psychotherapeutic interventions in these patients.