Caregivers and Left Ventricular Assist Devices as a Destination, Not a Journey

Kirkpatrick, James N.; Kellom, Katherine; Hull, Sarah C.; Henderson, Rebecca; Singh, Jasmeet; Coyle, Laura; Mountis, Maria; Shore, Elizabeth; Petrucci, Ralph J.; Cronholm, Peter F.; Barg, Frances K.

doi:10.1016/j.cardfail.2015.05.016

Cited by 35 publications

(29 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…transplant potentiality or device failure). 11,12,32-34 Additionally, patient physical symptoms have been previously associated with worse caregiver psychological health, 35 and our sample – like the broader population of VAD patients – had advanced HF (NYHA Class III/IV) that is characterized by a heavy burden of symptoms. Hence, it not surprising that we observed caregiver depression and anxiety that were numerically worse than national norms and published averages in HF caregiving samples.…”

Section: Discussionmentioning

confidence: 83%

“…Third, we observed a substantial burden of emotional distress for caregivers and a significant decline in QOL. Lack of preparation for the psychological burden of caregiving and the necessity of support systems for caregivers and patients are well-documented, 5,11,33 however, little is known about how support should be structured or potential costs/benefits. Importantly, despite difficulties, most patients and caregivers have minimal decisional regret.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy

et al. 2017

View full text Add to dashboard Cite

Background: Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device. Objective: The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation. Methods: This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes. Results: Patients’ QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers. Conclusions: This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Therefore, caregiver burden can be high during the postoperative period. 70,71 Stroke Approximately 6.6 million Americans (≥20 years old) have had a stroke. 7 Stroke and HIE after cardiac arrest can cause severe acute brain injury (in addition to traumatic brain injury), which threatens what many people consider their essence.…”

Section: Mechanical Circulatory Supportmentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

View full text Add to dashboard Cite

AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

show abstract

“…Therefore, we derived a list of core caregiver support domains from a growing conceptual peer-reviewed literature on the importance of caregiver involvement in LVAD and other health outcomes. [2][3][4][5][6][7][8][9] To create these domains, we incorporated pre-existing domains that were part of social work assessments (using Stanford Integrated Psychosocial Assessment for Transplantation variables as a starting point for our conceptual framework) and then added additional elements of caregiver support proposed anecdotally in other studies as potential factors impacting patient mortality after LVAD placement.…”

Section: Caregiver Support Domainsmentioning

confidence: 99%

Caregivers of Patients With Left Ventricular Assist Devices

Bruce

Minard

Wilhelms

et al. 2017

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Support emphasize the importance of caregiver support for left ventricular assist device (LVAD) placement, recommending that a lack of support should serve as a relative contraindication to device placement.1 Despite the integral role that caregivers are expected to play, findings from studies on LVAD caregivers are limited. Most of these studies are qualitative, exclusively focus on caregivers' experiences or burdens, and fail to examine specific mechanisms of support and the impact of caregiver support on patient mortality or morbidity events. 2-9How caregivers contribute to positive or negative patient mortality or morbidity events is unclear. Without this foundational understanding, there will be variability across LVAD programs and among candidates with regard to how much emphasis to place on caregiver support, how such support should be assessed, and at what threshold an absence of support becomes Background-How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers' psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients' post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support-defined morbidity events. Methods and Results-We retrospectively reviewed and recorded social workers' clinical assessments of adult patients implanted with durable continuous-flow LVADs as bridge to transplant, destination therapy, or bridge to decision from January 2010 to December 2014. Associations between caregiver characteristics and patient mortality and morbidity events were analyzed using Kaplan-Meier curves and Cox proportional hazards regression. Patient follow-up time was calculated as the time from hospital discharge until the earliest among death with LVAD, transplant, or the last day of the study (December 31, 2015). Patients were censored for death with LVAD at the time of transplant or the last day of the study. A total of 96 LVAD recipients were included in this study. Having a caregiver who understands the severity of the illness and options available to the patient (as determined and documented by the social worker; P=0.01), a caregiver who has identified a backup plan (P=0.02), and a caregiver who is able to provide logistical support (P=0.04) significantly mitigated risk of death. The risk of death for an LVAD patient was also significantly lower among those who have at least 1 adult child who lives within 50 miles (P=0.03) and those who have an extended family who can care for the patient (P=0.03). The risk of death was 3.1× more likely among patients who live alone compared with those who do not live alone (P=0.04). No caregiver characteristics were significantly associated with morbidity. Conclusions-This exploratory, hypothesis-generating study suggests that mortality after LVAD placement is impacted by caregiver u...

show abstract

Caregivers and Left Ventricular Assist Devices as a Destination, Not a Journey

Cited by 35 publications

References 17 publications

Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy

Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Caregivers of Patients With Left Ventricular Assist Devices

Contact Info

Product

Resources

About