A multi-modal intervention in management of left ventricular assist device outpatients: dietary counselling, controlled exercise and psychosocial support.
OBJECTIVE
Newer generation left ventricular assist devices (LVADs) are established for long-term support. The aim of this multi-modal intervention was to improve the body weight, exercise tolerance and psychosocial status in outpatients on long-term LVAD support.


METHODS
Seventy patients participated in this non-randomized intervention study [intervention group (IGr) n = 34; control group (CGr) n = 36] over 18 months (T1-T4); the baseline sample characteristics showed no differences between groups. Dietary counselling and weight management intervention was performed by a dietician based on a specific algorithm. Physical reconditioning followed a home ergometry protocol and was supplemented by psychosocial counselling. The outcomes were measured based on the body mass index (BMI), cardiopulmonary exercise testing and self-report [hospital anxiety and depression scale (HADS), SF-36].


RESULTS
The intervention showed a strong positive effect on nutrition and weight management [95% confidence interval (CI): -0.71-0.69; effect size (ES): 0.907; P = 0.02)], resulting in the normal BMI (kg/m(2)) values in the IGr (T1: 24.0 ± 0.6; T4: 24.5 ± 1.1; P = 0.35) compared with a significant BMI increase in the CGr (T1: 23.8 ± 0.6; T4: 29.7 ± 0.8; P = 0.05). Significant differences appeared regarding exercise tolerance (VO(2)max/% predicted) in favour of IGr patients (IGr: 69 ± 2.9; CGr 62 ± 3.7; P = 0.04). This increase was reflected by patients' self-reporting based on the SF-36 physical component score (IGr: P = 0.04; CGr: P = 0.54). SF-36 psychosocial component scores showed no changes for both groups. However, CGr showed a tendency for increased anxiety scores relative to their counterparts (IGr: 4.95 ± 0.4; CGr: 6.6 ± 0.9; P = 0.03).


CONCLUSIONS
IGr patients showed a strong benefit from a multi-modal intervention, including dietary counselling, controlled exercise and psychosocial support. Dietary counselling holds potential to prevent obesity in this patient population.
Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany. kugler.christiane@mh-hannover.de
Christiane
C
Kugler
Doris
D
Malehsa
Eva
E
Schrader
Uwe
U
Tegtbur
Elke
E
Guetzlaff
Axel
A
Haverich
Martin
M
Strueber
D000553:Ambulatory Care / Q000379:methods* / Q000523:psychology; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D015992:Body Mass Index; D003131:Combined Modality Therapy; D003376:Counseling; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D004035:Diet Therapy; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000523:psychology; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011581:Psychological Tests; D011788:Quality of Life; D057566:Self Report; D016896:Treatment Outcome