Quality of life outcomes after heart transplantation in individuals bridged to transplant with ventricular assist devices.
BACKGROUND
Increasing numbers of individuals receive ventricular assist devices (VADs) as bridges to heart transplantation. Physical morbidity risks and benefits, and quality of life (QOL) during VAD support have been documented. Effects of pre-transplant VAD support on functional and QOL outcomes after transplantation have received no empirical attention.


METHODS
Sixty-three VAD patients who received heart transplants underwent QOL evaluations of physical functioning, emotional and cognitive well-being, and social functioning at 2, 7, and 12 months after transplant (response rate = 95%). Ninety patients who had not received VADs--matched to the VAD group on cardiac-related and sociodemographic characteristics--served as longitudinal controls.


RESULTS
Both VAD and non-VAD groups showed similar levels and similar, statistically significant (p < 0.05) improvement in physical functioning (sleep, body care, mobility, ambulation, overall functional status, number of somatic complaints) across the study period. Emotional well-being (elevated depressive, anxiety, and anger symptoms; post-traumatic stress disorder rate) was stable or improved in both groups, and VAD patients showed significantly lower anxiety rates. The VAD patients' post-transplant cognitive status was significantly poorer. The VAD patients were significantly less likely to return to employment; other social functioning measurers (daily concerns, interpersonal activities/involvement, role function) showed mixed effects. Cognitive impairment explained much of the association between VAD support and post-transplant employment.


CONCLUSIONS
Although post-transplant physical and emotional recovery is similar in VAD and non-VAD patients, VAD patients retain more cognitive impairment and show mixed changes in social functioning. Increased attention to strategies to maximize VAD patients' cognitive capacity is required to facilitate social reintegration.
Dew
M A
MA
Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburg, Pennsylvania 15213, USA. DewMA@msx.upmc.edu
Kormos
R L
RL
Winowich
S
S
Harris
R C
RC
Stanford
E A
EA
Carozza
L
L
Griffith
B P
BP
D003071:Cognition; D004644:Emotions; D004651:Employment; D006304:Health Status; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D011788:Quality of Life