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

The experience of bodily image for patients with left ventricular assist device

Introduction

Mechanical Cardiac Support and Left Ventricular Assist Devices (LVAD) have been demonstrated to prolong Heart Failure patients' survival and improve their quality of life. LVAD implantation has a considerable effect on patients' body image. Patients find it hard to accept the device as an extension of their body, especially the driveline. The study aimed to examine the relationships between anxiety and depressive symptoms, acceptance of illness, beliefs about pain control, and quality of life with body image among LVAD-implanted patients.

Methods

The cross-sectional study included 54 conveniently recruited patients who completed the Body Image Scale, SF-12, Acceptance of Illness Scale, Beliefs about Pain Control Questionnaire, NRS, HADS, and demographic and clinical data. Multiple regression analyses examined the associations between the research variable.

Results

The mean Age of the participants was 59.64 (SD=9.63), and 96.3% were men. The mean scores were: Body Image Scale - 28.33 (SD=5,91); Acceptance of Illness Scale - 25.51 (SD=5.92); beliefs about pain control: internal factors - 15.85 (SD=4.96), the influence of physicians - 17.57 (SD=3.15), random events - 14.37(SD=3.32), NRS=2.80(SD=1.86), HADS anxiety - 5.33 (SD=4.12), HADS depression - 4.66 (SD=3.10), SF12MCS-45.49 (SD=6.48), SF-12PCS-41,33 (SD=6.48). The presence of anxiety and depressive symptoms and complications after LVAD significantly predicted low body image concerns.

Discussion

Healthcare professionals should be aware of challenges regarding body image faced by LVAD-implanted patients and address related factors, especially anxiety and depression.

Association Between the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation and Adjustment Disorder in Japanese Patients Using Ventricular Assist Devices as a Bridge to Heart Transplantation

OBJECTIVE

Ventricular assist device (VAD) serves as either a bridge to transplantation (BTT) or destination therapy (DT) for end-stage heart failure. In Japan, the extended wait time for heart transplants can make VAD usage for BTT comparable in duration to DT in other countries. Previous studies suggest that while DT patients experience improved quality of life post-VAD implantation, BTT patients often see a decline after two years. This study aims to explore the association between scores of the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J), adverse medical events (AMEs) and psychiatric disorders, particularly adjustment disorder (AD), in Japanese BTT patients.

METHODS

A retrospective analysis was conducted on 24 Japanese patients who underwent VAD implantation for BTT between August 2014 and December 2019. The SIPAT-J, which evaluates the patient's readiness level, social support system, psychological stability and psychopathology, and lifestyle and effects of substance use, was applied to medical records. Psychiatric diagnoses were reviewed to identify AMEs, AD and other conditions. Patients were grouped by AMEs and AD status, and SIPAT-J scores were dichotomized at the median to examine potential associations. Statistical analysis was performed using Fisher's Exact test.

RESULTS

There were no significant associations found between SIPAT-J scores and the development of AD or AMEs, likely due to the small sample size and varied observation periods, and differences in timing between diagnosis, evaluation, and VAD implantation. However, more than half of the patients developed psychiatric symptoms after VAD implantation, with delirium and insomnia being the most common. Identified stressors for AD included deteriorating family relationships, difficulty accepting heart disease, and future uncertainty. AMEs, which have been linked to AD onset in previous research, were also present in several cases.

DISCUSSION

This study is the first to examine the relationship between any version of SIPAT and psychiatric outcomes in BTT patients. The results suggest that while SIPAT-J captures important psychosocial factors, additional factors related to VAD-induced lifestyle changes and family dynamics may be crucial for predicting AD risk. Therefore, future research should consider a more detailed psychosocial evaluation to capture patient expectations about post-VAD life. Although preliminary, this study underscores the need for comprehensive psychosocial screening in BTT patients to facilitate early intervention and support for those at risk of AD.

Heart Transplantation and Left Ventricular Assist Devices: Long-Term Prognosis and Effects on Mental Health

Heart transplantation and left ventricular assist devices (LVADs) have emerged as crucial interventions for end-stage heart failure, dramatically improving patient outcomes. This narrative review examines their historical context, indications, procedures, and outcomes, as well as their impact on long-term survival, quality of life, functional status, and mental health. While heart transplantation remains the optimal treatment, donor scarcity limits its application. LVADs have become a viable alternative, either as a bridge to transplantation or as destination therapy. Both interventions demonstrate similar long-term survival rates and significant improvements in health-related quality of life and functional status. However, they present distinct long-term management challenges, including immunosuppression needs for transplant recipients and device-related issues for LVAD patients. Mental health effects are considerable, necessitating psychological support and adaptive coping strategies. Complications such as infection, bleeding, and thrombosis remain concerns for both interventions. Patient selection criteria, technological advancements, and long-term management strategies are critical factors in optimizing outcomes. Future research should focus on device miniaturization, enhanced biocompatibility, and less invasive insertion techniques to further advance these therapies and improve patient care in end-stage heart failure.

Effect of psychosocial factors on autonomic nervous system activity in patients with heart failure

Autonomic imbalance predicts worse clinical outcomes in patients with heart failure (HF). Managing the variables affecting heart rate variability (HRV) might improve the clinical outcomes of patients with HF. This study aimed to investigate variables affecting HRV. We assessed autonomic nervous system activity (low-frequency [Lf], high-frequency [Hf], and Lf/Hf ratio) in 60 patients with HF, employing standard measures to capture short-term HRV. To estimate the independent effects of variables such as well-known cardiac risk factors and psychosocial conditions on HRV, multivariate analyses were conducted. For psychosocial variables, we assessed depression and quality of life in patients and their family caregivers. We also assessed the self-care behavior of patients and their caregivers' burden. Depression in family caregivers and self-care behavior of patients were independently associated with a decreased Hf (β-coefficient = 0.309, P = .039 and β-coefficient = -0.029, P = .047, respectively). Depression of family caregivers and self-care behavior of patients may affect HRV in patients with HF.

Validity and reliability of the self-care behaviour scale for patients with left ventricular assist device

AIMS

To evaluate the validity and reliability of the self-care behaviour scale for patients with left ventricular assist devices.

DESIGN

Methodological study.

METHODS

The English version of the scale was translated into Korean, and it was then back-translated into English. Survey data were collected from 32 patients with left ventricular assist device in South Korea, and construct validity, content validity and reliability were analysed.

RESULTS

The original self-care behaviour scale comprises three domains and 33 items, whereas the Korean self-care behaviour scale comprises 27 items and five domains: device management, wound management, symptom monitoring, activated healthcare system and self-care management. Cronbach's alpha for the overall scale was 0.94, and that for the five domains ranged from 0.36 to 0.90. The intraclass correlation coefficient for the overall scale was 0.89, and the five domains ranged from 0.71 to 0.88.

CONCLUSION

The newly evaluated scale would be valid and reliable in measure self-care behaviour for patients with a left ventricular assist device.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Patients can manage the left ventricular assist device on their own based on evidence and use it as a tool for effective communication with medical professionals.

Muscle strength, aerobic capacity, and exercise tolerance are impaired in left ventricular assist devices recipients: A pilot study

Background: Left ventricular assist devices (LVAD) are increasingly being used as a therapy for advanced heart failure, both as a bridge to heart transplant and, given the rapid advances in the LVAD’s functionality and safety, and constant lack in availability of donor organs, as long-term destination therapy. With the diffusion of such therapy, it is crucial to assess patients’ muscle strength, aerobic capacity and exercise tolerance, to improve their functional capacity.

Methods: 38 LVAD recipients (33 men and five women) were included. Exercise testing including a maximal cardiopulmonary exercise test (CPET), handgrip, isometric and isokinetic strength testing of knee and ankle flexion/extension, and Romberg balance test in three conditions (eyes open, eyes closed, double task). Given the small and heterogeneous final sample size, a mostly descriptive statistical approach was chosen.

Results: 12 participants were classified as “Obese” (BMI>29.9). The most common comorbidities were type II diabetes and chronic kidney disease. Only 12 participants were able to successfully complete all the assessments. CPET and isokinetic strength trials were the least tolerated tests, and the handgrip test the best tolerated. Mean VO₂ peak was 12.38 ± 3.43 ml/kg/min, with 15 participants below 50% of predicted VO₂ max, of which 6 below 30% VO₂max. Mean handgrip strength was 30.05 ± 10.61 Kg; 25 participants were below the 25° percentile of their population’s normative reference values for handgrip strength, 10 of which were below the 5° percentile. Issues with the management of the external pack of the LVAD and its influence on the test limited the validity of the balance tests data, therefore, no solid conclusions could be drawn from them. VO₂ peak did not correlate with handgrip strength or with any of the lower limb strength measures.

Conclusion: LVAD recipients show greatly reduced functional capacity and tolerance to exercise and exercise testing, with low overall strength levels. As strength variables appear to be independent from VO₂ peak, different lower limbs strength tests should be explored to find a tolerable alternative in this population, which is subjected to muscle wasting due to old age, reduced tissue perfusion, side effects from the pharmacological therapies, and prolonged periods of bedrest.

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support

The utilization of left ventricular assist devices (LVADs) in end-stage heart failure has doubled in the past ten years and is bound to continue to increase. Since the first of these devices was approved in 1994, the technology has changed tremendously, and so has the medical and surgical management of these patients. In this review, we discuss the history of LVADs, evaluating survival and complications over time. We also aim to discuss practical aspects of the medical and surgical management of LVAD patients and future directions for outcome improvement in this population.