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Author Notes:

Correspondence to: Julie T. Bidwell, PhD, RN, Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd, Room 341, Atlanta, GA 30322. E‐mail: julietbidwell@gmail.com

Julie T. Bidwell is currently located at the Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd, Atlanta, GA.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health, or Emory University.

Disclosures: None.

Subjects:

Research Funding:

This work was partially funded from Emory University's Open Access Publishing Fund.

This work was supported by the National Institutes of Health/National Institute of Nursing Research F31NR014760 and T32NR012715 (Bidwell) and R01NR013492 (Lee).

Keywords:

  • caregivers
  • heart failure
  • quality of life
  • ventricular assist device

Patient and caregiver determinants of patient quality of life and caregiver strain in left ventricular assist device therapy

Tools:

Journal Title:

Journal of the American Heart Association

Volume:

Volume 7, Number 6

Publisher:

, Pages e008080-e008080

Type of Work:

Article | Final Publisher PDF

Abstract:

Background--Although current guidelines emphasize the importance of social support to the success of left ventricular assist device (LVAD) therapy, few studies examine the influence of the caregiver on patient outcomes or quantify the impact of LVAD caregiving on caregiver outcomes. The purpose of this analysis was to identify patient and caregiver determinants of patient quality of life (QOL) and caregiver strain in response to LVAD therapy. Methods and Results--Data on patients receiving LVAD therapy and their caregivers (n=50 dyads) were prospectively collected pre-implantation and 1, 3, and 6 months post-implantation. Growth curve modeling was used to describe change in patient QOL (Kansas City Cardiomyopathy Questionnaire) and caregiver strain (Multidimensional Caregiver Strain Index). Patient QOL improved most in the first month (β=23.22±3.76, P < 0.001), followed by gradual gains over 6 months (β=1.90±0.64, P<0.01). Caregivers experienced worsening of strain in the first month (β=4.30±1.42, P < 0.01), followed by gradual resolution to pre-implantation levels by 6 months (β=-0.71±0.23, P < 0.01). Worse pre-implantation patient symptoms were associated with greater improvement in patient QOL (β=0.53±0.19, P < 0.01) but worsening caregiver strain (β=0.15±0.07, P=0.04). Better relationship quality was associated with greater improvement in patient QOL (β=14.39±5.85, P=0.01) and less pre-implantation caregiver strain (β=-9.31±2.28, P < 0.001). Nonspousal caregivers experienced less pre-implantation strain (β=-8.60±3.10, P=0.01), and patients with nonspousal caregivers had less improvement in QOL (β=-3.70±1.62, P=0.02). Conclusions--A combination of patient and caregiver characteristics predicts patient and caregiver response to LVAD therapy. Including caregiver factors in future studies may be helpful in developing interventions that improve patient and caregiver outcomes, together.

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© 2018 The Authors.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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