Post-Discharge Quality of Life in Patients Receiving a Long-Term Ventricular Assist Device: Focus on Anxiety, Depression and Post Traumatic Stress Disorder

Abstract

Reported outcomes after left ventricular assist device (LVAD) implant include mortality, hospital readmission and severe adverse events. We have less information about patients' perceptions of their quality of life (QOL) after hospital discharge. We conducted a prospective two-center international pilot study to assess anxiety, depression and post-traumatic stress disorder (PTSD) following LVAD implant as bridge to transplant (BTT) or destination therapy (DT). 124 patients ≥ 30 days after discharge post-implant were assessed telephonically or during on-site clinic visits. GAD-7 is a 7 item scale assessing anxiety; PHQ-9 is a 9 item scale assessing depression; and IES-R is a 22 item scale reflecting self-described symptoms of PTSD. EQ-VAS is a 1 item response reflecting health self-assessment from 0-100 (worst to best imaginable). Mean patient age was 57.5±15.2 yrs; 15% female; 47% >1 yr post-implantation; 56% DT; 67% had HeartMate 3. High scores for anxiety and depression (some with suicidal ideation) warranted further evaluation in 18% and 8% of patients respectively. Risk of severe anxiety was higher in patients < 60 yrs (p <0.01). 23% of patients had scores consistent with PTSD, and in 80% of these it was moderate to very severe. The risk of anxiety, depression and PTSD was highest in the patients with EQ-VAS <50 (p <0.05) (Figure). No differences related to gender or LVAD strategy. Although the majority of LVAD out-patients reported low levels of anxiety, depression and did not exhibit symptoms of PTSD, an important minority had symptoms severe enough to warrant evaluation for therapeutic intervention. A low EQ-VAS may be helpful in identifying patients at risk but does not specify its nature or severity. Standardized, regular assessments with GAD-7, PHQ-9 and IES-R may help to identify patients in urgent need of evaluation for severe anxiety, depression (including suicidal ideation) and PTSD.