Does listing for heart transplant for longer than 30 days before ventricular assist device implantation influence utilization of psychotherapeutic support and outcome?
OBJECTIVE
Previous studies indicate that patients with mechanical ventricular assist devices (VADs) experience high psychosocial and emotional distress. Listing for transplant may trigger psychosocial adjustment to the transplantation as an upcoming critical life-event. We hypothesized that patients could profit from this adaptation when implantation of a VAD becomes necessary.


METHODS
We arbitrarily chose a cut-off at 30 days after being put on the heart transplantation (HTX) waiting list. Eighteen patients were listed for HTX for >30 days (referred to as 'listed') and 26 for shorter periods or not at all ('non-listed'). Survival, the occurrence of mental disorders, the number of contacts of the patient with the psychologist and times spent on psychotherapeutic support for both patient groups and for their families were analysed.


RESULTS
Survival after VAD implantation (observation time) and mental disorders were comparable for listed and non-listed patients. Mental disorders were developed in 80% of all patients irrespective of the listing group. The utilization of supportive psychotherapy did not differ between the listed and the non-listed group with regard to the number of contacts and to the time needed for individual therapy. Moreover, the number of families who requested support did not differ between the groups nor did the time spent on family therapy. However, the number of contacts and the time for individual psychotherapeutic support correlated with the observation time, whereas the time spent on family therapy did not. In contrast, family therapy correlated inversely with age. In addition, we compared bridge-to-transplantation patients with destination therapy patients. There were no differences in the occurrence of mental disorders, the number of contacts or in the time expenses for individual and for family therapy, neither for all patients nor after stratification for listing.


CONCLUSIONS
Our data indicate that listing for HTX for >30 days before VAD implantation does not reduce the utilization of psychotherapeutic support by VAD patients. We assume that structured emotional and psychosocial support by the interdisciplinary VAD team, including professional supportive psychotherapy, is indispensable for successful coping of VAD patients and their families.
Department of Cardiovascular Surgery Freiburg, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany. claudia.heilmann@uniklinik-freiburg.de
Claudia
C
Heilmann
Nicola
N
Kuijpers
Friedhelm
F
Beyersdorf
Georg
G
Trummer
Michael
M
Berchtold-Herz
Wolfgang
W
Zeh
Anna Lena
AL
Stroh
Kurt
K
Fritzsche
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005196:Family Therapy / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000601:surgery; D016027:Heart Transplantation / Q000523:psychology*; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D011613:Psychotherapy / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult