Introduction: For heart failure (HF) patients requiring a left ventricular assist device (LVAD), illness severity likely influences outcomes not only for patients, but also for family caregivers who are heavily involved with management. The purpose of this analysis was to determine if greater pre-LVAD HF severity was a predictor of worse quality of life (QOL) and psychological symptoms (depression, anxiety) in LVAD patients and their caregivers.
Methods: This was a prospective, longitudinal study of LVAD patient-caregiver dyads (n=50). Data were collected pre-LVAD and at 1, 3, and 6 months post-LVAD. Dyadic multilevel models were used to quantify change in patient and caregiver QOL (EuroQOL Visual Analogue Scale), depression (Patient Health Questionnaire 8), and anxiety (Brief Symptom Inventory). Pre-LVAD symptom severity (HF Somatic Perception Scale), continuous inotrope requirement, and perceived control of HF (Control Attitudes Scale Revised) were examined as potential determinants.
Results: Patients were 54.6 ± 13.9 years, 84% male, and largely Bridge to Transplant (72%). Caregivers were mostly spouses (76%), 54.7 ± 12.5 years, and 82% female. Patient QOL, depression, and anxiety improved over time (β=3.9±0.6, p<0.01; β=-1.0±0.1, p<0.01; β=-0.1±0.0, p<0.01). Caregiver depression and anxiety did not change, while QOL worsened (β=-1.0±0.3, p=0<0.01). Pre-LVAD HF symptom severity was associated with worse pre-LVAD patient depression (β=0.1±0.0, p=0.02) and worse caregiver QOL (β=-1.0±0.3, p<0.01). Inotropes were associated with worse caregiver pre-LVAD depression and anxiety (β=2.6±1.0, p=0.02; β=0.3±0.1, p=0.02). Greater perceived control was associated with better pre-LVAD patient QOL (β=12.2±2.4, p<0.01) and less patient and caregiver anxiety (β=-0.3±0.1, p=0.03; β=-0.3±0.1, p=0.02), but slower improvement in patient QOL and anxiety over time (β=-2.4±0.7, p<0.01 and β=0.1±0.0, p=0.02).
Conclusions: Understanding the influence of HF symptom severity and perceived control on QOL and psychological symptoms for patient-caregiver dyads both before and after implant may assist in clinical evaluation and assessment for additional supportive interventions.