title: Cognition and adherence are self-management factors predicting the quality of life of adults living with a left ventricular assist device.
abstract: BACKGROUND
  There is no empirical study about the context and influence of self-management (SM) factors on quality of life (QOL) among adults with left ventricular assist device (LVADs). The purpose of this study was to close this knowledge gap by: (1) differentiating select SM factors (e.g., cognition) and overall QOL based on LVAD implant durations; (2) examining the relationships among SM factors and QOL variables; and (3) identifying which SM factors predict QOL.
  
  
  METHODS
  An observational study was employed including 87 LVAD patients, ages 20 to 80 years, with mean implant durations of 18.5 ± 15.1 months. Patients completed 1 demographic questionnaire and 6 measures of SM factors (cognition-general and executive function, LVAD self-efficacy, care dependency and adherence) and QOL. Data were analyzed with descriptive and inferential statistical procedures.
  
  
  RESULTS
  There was no significant difference in SM factors and overall QOL by LVAD implant durations. SM factors, including cognitive function, LVAD self-efficacy, and adherence, correlated positively with QOL (r = 0.35 to 0.48, p < 0.05), but LVAD care dependency correlated negatively with QOL (r = -0.21, p < 0.05). The general and executive function of cognition and LVAD adherence were significant predictors of QOL.
  
  
  CONCLUSIONS
  The data inferred that higher level of cognitive function is associated with higher self-efficacy, adherence and greater QOL, whereas lower care dependency is associated with greater QOL. Higher cognitive function and adherence to the LVAD care regimen predicted better QOL outcome. Further research is needed to elucidate the mechanism by which SM factors influence QOL in adults with long-term LVADs.
authors.affiliation: University of Michigan School of Nursing, Ann Arbor, Michigan; USA. Electronic address: jcasida@umich.edu.
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Casida
authors.affiliation: Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, Missouri, USA.
authors.forename: Horng-Shiuann
authors.initials: HS
authors.lastname: Wu
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Abshire
authors.affiliation: University of Michigan School of Nursing, Ann Arbor, Michigan; USA.
authors.forename: Bidisha
authors.initials: B
authors.lastname: Ghosh
authors.affiliation: University of Michigan School of Nursing, Ann Arbor, Michigan; USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Yang
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D000073278:Self-Management / Q000523:psychology*; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: LVAD adherence; LVAD care dependency; LVAD self-efficacy; LVAD self-management; cognitive function; quality of life