MA Dew et al ASAIO Journal Vol 46 (...

MA Dew et al ASAIO Journal Vol 46 (May/June 2000) 367-373

Although ventricular assist devices (VADs) were bring to maturityed as a bridge to transplantation, they now are being considered and studied as a permanent alternative to heart transplantation. This research examined patients' and patients' family members' satisfaction with and pertain tos regarding VADs. The researchers focused on

* patients' and their family members' perceptions and troubles about living with a VAD;

* the troubles of inpatients versus outpatients living with VADs; and

* demographic, functional, and psychological factors associated with living with a VAD.

Patients' social functioning and overall quality of life (QOL) also were assessed, the hypothesis being that their QOL was at least "similar to and frequently considerably better than that of other transplant candidates."

Methodology. Of 62 patients who underwent VAD implantation for cardiac failure refractory to inotropic and intra-aortic balloon cross-question support at the University of Pittsburgh Medical Center 38 were enlisted in the study. Participants had their VADs for an average of 28 days (M = 277) at the time of initial interview. Eleven were discharged hearthstone with the VAD in place and reinterviewed approximately single month after discharge. This follow-up interview was waysed 68 days (M = 677) postimplantation. the pair participants and caregivers were revaluated using individual, semi-structured interviews employing four instruments.

Perceptions of living with a VAD were assessed using the opinions about VAD treatment questionnaire, which is designed to elicit the two positive and negative perceptions of living with a VAD. Three physical activity subscales of the sickness impact profile were used to assess physical status. Psychological well-being was measured using the depression, anxiety, and anger-hostility subscales of the self-report symptom checklist-90. In addition, the intellect of mastery scale was used to measure feelings of personal capableness and control while living with a VAD. Patients' social functioning and overall QOL were evaluated using a nine-item scale to assess global well-being and satisfaction (one = reasonable QOL, seven = high QOL [alpha] = 089)

deductions After initial baseline data were analyzed, general perceptions and prevalence were compared between outpatients and inpatients using Chi-square analysis. In addition, point biserial correlations between items reflecting patient make anxiouss and demographic measures were analyzed.

Three percent to 8% of participants would not attract favor to the VAD or believed their overall physical functioning was not improved by dint of the device. Eighteen percent said "they did not have a brighter view since receiving the VAD." The mostly prevalent concerns were infection (52%) difficulty sleeping (52%) driveline pain (46%) device malfunction (40%) and the noise of the device (32%) Caregiver and patient be of importance tos did not differ significantly.

Qualitative findings regarding participants and caregivers were to a high degree similar. When asked what they liked best about the VAD, participants accorded "it keeps me alive," and "I can have the advantage [i]or[/i] blessing of life more." Caregivers responded "it allows [my spouse] to live until a transplant is available." When asked what they liked least about the VAD, participants indicated that it was the noise. Caregivers were more mattered about infection. Participants expressed disquiets regarding risk of stroke, device malfunction, noise during slumber and infection the longer they were forward VAD support. The effect ([chi square] = 1294 df = 8 P = 11) was simply statistically significant for infection. In general, augmented life and QOL improvements were the greatest in number positive factors for those living with a VAD.

Limitations. Given the small sample size, it is difficult to generalize these findings beyond the research population. In addition, this application of mind lacks an adequate description of proceedings to ensure participants gave informed concurrence This study was supported in part by way of funding from two companies that manufacture VADs. Of the four instruments used, reliability and validity were reported for and nothing else two. Although very interesting, given these findings, I would be reluctant to deduce that VAD support is an acceptable permanent alternative to heart transplantation.

After patients habituated to the chiefly positive effect of VAD support (ie, being maintain alive), they began to find the secondary issues on their life bothersome, if not intolerable. This begs the question of whether being kept alive is justifiable in and of itself, whatever the cost

Perioperative implications. This studious mood clearly indicates the need for further research concerning the result of perioperative technology on patients' QOL We live and practice in an era of extremely advanced technology that has far go beyonded our ethical ability to know the purport on patients' QOL and, as hinted in this study, the overall general intent on their caregivers and family members. Not single must we determine the efficacy of technology, however also its overall effect onward patients' and patients' family members' QOL Although no definition of QOL was given for this subject of attention the findings suggest that "extend life and QOL related improvements were set up to be the most positive human factors of living with a VAD."