Patient-Reported Outcomes in Left Ventricular Assist Device Therapy

Abstract

Patient-reported outcomes in left ventricular assist device therapyBrouwers, C.J.; Denollet, J.; de Jonge, N.; Caliskan, K.; Kealy, J.; Pedersen, S.S. General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policyIf you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. Background-Technological advancements of left ventricular assist devices (LVAD) have created today's potential for extending the lives of patients with end-stage heart failure. Few studies have examined the effect of LVAD therapy on patient-reported outcomes (PROs), such as health status, quality of life, and anxiety/depression, despite poor PROs predicting mortality and rehospitalization in patients with heart failure. In this systematic review, we provide an overview of available evidence on the impact of LVAD therapy on PROs and discuss recommendations for clinical research and practice. Methods and Results-A systematic literature search identified 16 quantitative studies with a sample size Ն10 (meanϮSD ageϭ50.1Ϯ12.6 years) that examined the impact of LVAD therapy on PROs using a quantitative approach. Initial evidence suggests an improvement in health status, anxiety, and depression in the first few months after LVAD implantation. However, PRO scores of patients receiving LVAD therapy are still lower for physical, social, and emotional functioning compared with transplant recipients. These studies had several methodological shortcomings, including the use of relatively small sample sizes, and only a paucity of studies focused on anxiety and depression. Conclusions-There is a paucity of studies on the patient perspective of LVAD therapy. To advance the field of LVAD research and to optimize the care of an increasingly growing population of patients receiving LVAD therapy, more well-designed large-scale studies are needed to further elucidate the impact of LVAD therapy on PROs. (Circ Heart Fail. 2011;4:714-723.)Key Words: left ventricular assist device Ⅲ patient-reported outcomes Ⅲ quality of life Ⅲ review

Anxiety and Depression in Cardiovascular Surgery

“…examined the impact of LVAD therapy, including both pulsatile devices and continuousflow devices, on patients' health status and anxiety/depression [27]. They suggested that patients had improved their health status, anxiety, and depression in the first few months after LVAD implantation and that those scores of patients receiving LVAD therapy were still below for physical, social, and emotional functioning compared with transplant recipients.…”

Should Left Ventricular Assist Device Be Standard of Care for Patients With Refractory Heart Failure Who Are Not Transplantation Candidates?

“…Is survival our only standard in the absence of enhanced quality of life? Currently, we lack patient-reported outcomes with respect to quality of life after LVAD, 3 and as a nation, we spend Ϸ16% of our gross domestic product on health care, without including the potential widespread dissemination of this costly therapy. To suggest that all patients ineligible for transplantation should receive a VAD is equivalent to mandating that all persons ineligible for an automobile driver's license be licensed to pilot a jet.…”

Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device

“…When heart failure is in an advanced stage and the clinical condition allows, the patient can be put on the transplant list. However, the number of organs available for transplant is lower than the demand [4,5]. Another treatment option in advanced heart failure is mechanical ventricular support, which can be offered to patients who meet pre-determined criteria for inclusion [6].…”