Implant Strategy–Specific Changes in Symptoms in Response to Left Ventricular Assist Devices

Abstract

There are many differences in the magnitude and timing of change in symptom responses to LVAD between bridge and destination therapy patients. Detailed information on changes in specific symptoms may better inform shared decision-making regarding LVAD.

Psychological Spectrum Experienced by Heart Failure Patients After Left Ventricular Assist Device Implantation

“…The two-year survival of LVAD patients, when compared with optimal medical management (OMM) patients in INTERMACS 4 group met all-composite end-point with improvements in (1) New York Heart Association (NYHA ) functional class (≥1 class), (2) EuroQoL (EQ)-5D visual analog scale (VAS) (>20 points), and (3) Patient Health Questionnaire - 9 (PHQ-9) score (≥5 points) (P<0.001) [ 19 ]. In a study by Lee et al, during the follow-up period of 6 months, LVAD patients in both patient groups (destination therapy and bridge to transplant) showed similar significant improvements in HRQOL, and significant improvement in shortness of breath, while moderate to significant improvements in wake disturbances [ 20 ]. A similar study, also conducted by Lee et al, showed significant improvement in shortness of breath (<0.001) and fatigue within 30 days after LVAD implantation, which was followed by subsequent improvement through 180 days [ 21 ].…”

Identifying subgroups: Part 2: Trajectories of change over time

“…In some situations we already know which trajectory participants should fall; this may be the case when applying LGMM to experimental designs, or if there are known differences between patient groups (this is called "known class" analysis -see example comparing patients who received an LVAD as a bridge to transplantation vs as destination therapy). 19 But, it is more often the case that we do not yet know which trajectory participants belong to, and therefore have to begin the iterative process of identifying the number of trajectories, and allow participant membership in trajectories to be data-driven.…”

“…Common extensions of LGMM, including predicting trajectory membership, 7,11,24,25 known group analysis, 8,19 and linking trajectories to outcomes, 5 are presented in Table 3.…”

“…In a prior paper, known group LGMM was used to evaluate differences in how physical and affective symptoms change in response to LVAD implantation. 19 Using this approach, intercepts and slopes can be generated for each known group and then compared using random effects. As an example finding, destination therapy patients had worse pre-implant dyspnea and wake disturbances, and they experienced greater initial improvements in these symptoms compared with bridge to transplant patients.…”

“…As an example finding, destination therapy patients had worse pre-implant dyspnea and wake disturbances, and they experienced greater initial improvements in these symptoms compared with bridge to transplant patients. 19 Known group analysis also was used in a recent publication on stroke survivors and their care partners. 8 First, LGMM was used to identify three distinct trajectories of stroke survivor quality of life.…”