title: Caregivers of Patients With Left Ventricular Assist Devices: Possible Impacts on Patients' Mortality and Interagency Registry for Mechanically Assisted Circulatory Support-Defined Morbidity Events.
abstract: How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers' psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients' post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support-defined morbidity events.
  
  
  
  We retrospectively reviewed and recorded social workers' clinical assessments of adult patients implanted with durable continuous-flow LVADs as bridge to transplant, destination therapy, or bridge to decision from January 2010 to December 2014. Associations between caregiver characteristics and patient mortality and morbidity events were analyzed using Kaplan-Meier curves and Cox proportional hazards regression. Patient follow-up time was calculated as the time from hospital discharge until the earliest among death with LVAD, transplant, or the last day of the study (December 31, 2015). Patients were censored for death with LVAD at the time of transplant or the last day of the study. A total of 96 LVAD recipients were included in this study. Having a caregiver who understands the severity of the illness and options available to the patient (as determined and documented by the social worker; P=0.01), a caregiver who has identified a backup plan (P=0.02), and a caregiver who is able to provide logistical support (P=0.04) significantly mitigated risk of death. The risk of death for an LVAD patient was also significantly lower among those who have at least 1 adult child who lives within 50 miles (P=0.03) and those who have an extended family who can care for the patient (P=0.03). The risk of death was 3.1× more likely among patients who live alone compared with those who do not live alone (P=0.04). No caregiver characteristics were significantly associated with morbidity.
  
  
  
  This exploratory, hypothesis-generating study suggests that mortality after LVAD placement is impacted by caregiver understanding of patient severity of illness and caregiver presence. This study provides initial evidence to support further work in understanding the associations between caregivers and LVAD patients, as well as interventions that may improve patient outcomes.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02248974.
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.). crbruce@bcm.edu.
authors.forename: Courtenay R
authors.initials: CR
authors.lastname: Bruce
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Charles G
authors.initials: CG
authors.lastname: Minard
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: L A
authors.initials: LA
authors.lastname: Wilhelms
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Abraham
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Javier
authors.initials: J
authors.lastname: Amione-Guerra
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Linda
authors.initials: L
authors.lastname: Pham
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Sherry D
authors.initials: SD
authors.lastname: Grogan
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Barry
authors.initials: B
authors.lastname: Trachtenberg
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Martin L
authors.initials: ML
authors.lastname: Smith
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bruckner
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
authors.affiliation: From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.).
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Kostick
mesh_terms: D017028:Caregivers / Q000523:psychology*; D032882:Comprehension; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D006353:Heart-Assist Devices; D006801:Humans; D007398:Interpersonal Relations; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support; D000068217:Social Workers; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: adult; caregivers; death; family; social workers