Background: Advanced heart failure patients with left ventricular assist device (LVAD) have experienced emotional distress and psychological sequelae following implant. However, few studies have examined stress among patients with LVAD. The purpose of this study was to describe physiological and psychological stress response and then to examine relationships between physiological and psychological stress response and outcomes (quality of life (QOL), functional status and healthcare utilization) in patients with LVAD.
Design: A descriptive observational study design was used to examine physiological and psychological stress response among LVAD patients.
Methods: Data was collected for patients more than 3 months post-LVAD implantation (N = 44). Relationships among indicators of physiological (salivary cortisol, sleep quality) and psychological stress, (perceived stress, depression and fatigue) and outcomes (quality of life, functional status as measured by Six Minute Walk Test (6MWT) and healthcare utilization, using hospitalization rate) were examined using descriptive statistics and logistic regression models.
Results: The sample was average age 57.7 years, mostly male (73%), married (70.5%) and racially diverse (white 46%, black 43%, other 11%). Median LVAD support was 18.2 months. Normal cortisol awakening response was seen in most participants (61%). LVAD patients reported moderate levels of psychological stress and sleep quality and enjoy a good quality of life (73 out of 100, SD ± 13.5). At the bivariate level, normal cortisol awakening response was correlated with low depressive symptoms (p< 0.02). Poor sleep quality was correlated with increased psychological stress response and QOL (p< 0.01). Perceived stress was positively associated with healthcare utilization (p<0.01). In multivariate analysis, cortisol and sleep quality were independent predictors of 6MWT > 300 meters (R2 = 0.33, chi2 = 0.002), but not for QOL and healthcare utilization when controlling for psychological stress.
Conclusions: This is the first report of salivary cortisol and perceived stress in outpatients with LVAD. Associations were seen between sleep quality, psychological stress response and QOL. Cortisol and sleep quality were predictive of functional status among patients with LVAD. Future research should explore if those with a higher stress profile (abnormal cortisol awakening response, worse sleep quality, perceived stress, depression, fatigue) would benefit from tailored supportive interventions to lower perceived stress, improve sleep quality and improve QOL.