Abstract
The number of Left Ventricular Assist Devices (LVADs) implanted each year is rising. Nevertheless, there are minimal data on device acceptance after LVAD implant, and on its relationship with patient-reported outcomes. We designed a cross-sectional study to address this knowledge gap and test the hypothesis that low device acceptance is associated with poorer quality of life, depression and anxiety. Self-report questionnaires were administered to assess quality of life (12-item Kansas City Cardiomyopathy Questionnaire quality of life subscale), level of anxiety (7-item Generalized Anxiety Disorder; GAD-7), level of depression (9-item Patient Health Questionnaire; PHQ-9) and device acceptance (Florida Patient Acceptance Survey; FPAS) to 101 consecutive patients presenting to LVAD clinic. Regression analysis showed a strong correlation between device acceptance and both psychological distress (p < 0.001) and quality of life (p < 0.001). Analysis of the sub-scales of the FPAS showed that patients had significant body image concerns, but return to function and device-related distress were the main drivers of the observed correlation between device acceptance and patient well-being. Younger age was associated with lower device acceptance (r = 0.36, p < 0.001) and lower quality of life (r = 0.54, p < 0.001). These findings suggest that interventions targeting device acceptance should be explored to improve outcomes in LVAD recipients.
Highlights
The few small studies that have investigated the impact of Left Ventricular Assist Devices (LVADs) therapy on psychological distress[1] have generally found that LVAD recipients experience symptoms of depression and anxiety immediately after implant[2], but their psychological distress diminishes over time[3,4,5,6]
Sixty-five % of the patients originally received the device as a Destination Therapy (DT).Older patients were more likely to be www.nature.com/scientificreports
This study shows that (1) about a quarter of real-world stable patients living with an LVAD experience clinically relevant levels of depression or anxiety and that (2) poor device acceptance is associated with higher levels of psychological distress
Summary
The few small studies that have investigated the impact of LVAD therapy on psychological distress[1] have generally found that LVAD recipients experience symptoms of depression and anxiety immediately after implant[2], but their psychological distress diminishes over time[3,4,5,6]. One study reported that moderate symptoms of anxiety and depression may remain at least six months after the implant in spite of improved indices of quality of life (QoL)[7]. One study found that LVAD recipients positively evaluated their experience with the device immediately after surgery but tended to be less satisfied with the device as time from the implant increased due to worsening in physical functioning[11]. More needs to be known about the impact that partially externalized LVADs have on body-image perception
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