Professional Employment in Patients on Ventricular Assist Device Support - A Multi-Center Prevalence Study

Abstract

<h3>Purpose</h3> This study aimed to assess a larger sample of patients on ongoing VAD support with respect to professional employment rates as a surrogate measure for functional recovery, and psychosocial reintegration, explore determinants, and the impact of adverse events on professional employment. <h3>Methods</h3> A national, multi-center study considered point prevalence rates of professional employment and its relation to sociodemographic (age, gender, education, family), psychosocial (anxiety, depression, quality of life (QoL)), and clinical adverse (thromboembolic, bleeding, driveline infection) outcomes in a sample of 375 stable outpatients. Valid patient-reported outcome measures were administered (WPI, KCCQ, HADS). <h3>Results</h3> The overall sample consisted of 14.1% female patients, mean age 58±11years, time post-implant ranged from 3-36mts. A minority of 10.3% were full- or half-time employed, 30.7% reported to be retired age-related, and 59.2% were unemployed or retired illness-related. Employed patients were more likely to be younger (p<0.001), single (p<0.001), and hold a higher educational degree (p<0.001). Those employed reported better QoL based on the KCCQ overall score (MANOVA p=0.005), less anxiety (73.7% vs. 18.4%, χ²p=0.015), and depression (57.9% vs. 36.8%, χ²p=0.255) rates in comparison to their counterparts. Clinical adverse events in those employed included thromboembolic (15.8%), and bleeding events (10.5%), and driveline infections (31.6%) and had no impact on employment rates. Binary log odds indicated age (categorized over 65 vs under 65) being the only variable explaining the probability of being employed or retired age-related (4.43; 95% CI 3.13, 5.74), but not for those being retired disease-related (-0.22; 95% CI -1.51, 1.08). <h3>Conclusion</h3> In this national sample, employment rates in patients on ongoing VAD support were rather small; however those employed perceived better QoL and less anxiety. Employment was not related to clinical adverse events relevant to this population. Future clinical strategies need to be initiated to support psychosocial re-integration in terms of professional employment for patients on VAD support being in those in the respective age ranges.