title: Quality of life and emotional distress early after left ventricular assist device implant: a mixed-method study.
abstract: Patients who temporarily or permanently rely on left ventricular assist devices (LVADs) for end-stage heart failure face complex psychological, emotional, and relational problems. We conducted a mixed-method study to investigate quality of life, psychological symptoms, and emotional and cognitive reactions after LVAD implant. Twenty-six patients admitted to cardiac rehabilitation were administered quality of life questionnaires (Short Form 36 of the Medical Outcomes Study and Minnesota Living with Heart Failure Questionnaire), the Hospital Anxiety and Depression Scale, and the Coping Orientation for Problem Experiences inventory, and underwent three in-depth unstructured interviews within 2 months after LVAD implant. Quality of life assessment (Short Form 36) documented persistently low physical scores whereas mental component scores almost achieved normative values. Clinically relevant depression and anxiety were observed in 18 and 18% of patients, respectively; avoidant coping scores correlated significantly with both depression and anxiety (Pearson correlation coefficients 0.732, P < 0.001 and 0.764, P < 0.001, respectively). From qualitative interviews, factors that impacted on LVAD acceptance included: device type, disease experience during transplant waiting, nature of the assisted organ, quality of patient-doctor communication, the opportunity of sharing the experience, and recipient's psychological characteristics. Quality of life improves early after LVAD implant, but emotional distress may remain high. A multidimensional approach that takes into account patients' psychological characteristics should be pursued to enhance LVAD acceptance.
authors.affiliation: Cardiac Rehabilitation S. Maria Nascente, IRCCS Fondazione Don Gnocchi, Milan, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Modica
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferratini
authors.forename: Anna
authors.initials: A
authors.lastname: Torri
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Avoidant coping; Left ventricular assist device; Mechanical circulatory support; Psychological symptoms; Qualitative interview; Quality of life