Younger Patients Have Poorer Social Functioning Than Older Patients after LVAD Placement

Abstract

Purpose Left ventricular assist devices (LVADs) are increasingly common, approximating 2,500 implants a year. The average age at implant in the modern era is 52 years. Data from more than 15,000 patients participating in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database demonstrate improved quality of life (QOL) after LVAD implant and through 24 months. However, there is a paucity of data in evaluating how patients who are older vs. younger contend with the social impact of living with a LVAD. Challenges may include addressing the impact of an LVAD on social interactions, employment, finances, self-image and intimacy based on the patient's age. Methods A multi-site prospective, descriptive study evaluated QOL using the QOLVAD questionnaire. We report preliminary findings for Social Domain scores (possible range 0-100 with a higher scores suggesting better functioning). Two-sample T-tests were used to compare social wellbeing for younger (n=68) vs. older patients (n=118). Results The overall sample (n=186) was 58.5±13.8 years old, 82.7% were male, 77.3% were white, 50% were bridge to transplant, 30% destination therapy. Surveys were completed at median time (25th, 75th percentile) of 44 weeks (17.5, 115.5) post-VAD. The average social domain score (n = 185) was 73.4 ± 16.7. Patients 55 and younger had a mean social domain score of 68.8 ± 17.5, which was significantly higher than patients age 56 and older who had a mean score of 76.0 ± 15.7 (p=0.006). Conclusions The findings suggest younger patients struggle more socially than older patients do after LVAD implant. Future interventions may consider class topics such as how to re-enter the work force, including work with local agencies focused on vocational rehabilitation after LVAD placement. Patient education and support groups for younger patients could include topics of intimacy and sexuality particularly for younger patients. Innovative support could include collaborating with clothing industries to design garments that support and improve self-image. Future research on the impact and success of such interventions could be measured using the QoLVAD tool.