PITTSBURGH, April 24 -- Home may be where the heart is, but it is also where heart patients on left ventricular assist devices (LVAD) fair the best, according to a University of Pittsburgh School of Medicine study, the results of which were presented today at the 44th annual American Society for Artificial Internal Organs (ASAIO) conference in New York City.
"This is the first large-scale study to examine how LVAD heart patients do in terms of total health when they are discharged from the hospital, not just how their heart functions," commented Mary Amanda Dew, Ph.D., associate professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh. "Reports to date have looked at the physical rehabilitation of discharged patients," Dr. Dew continued, "but the significant improvements in other quality of life factors, such as mental health, social functioning, and general life satisfaction -- which are actually just as important when evaluating a patient's health -- have been largely ignored."
Pitt researchers from the departments of Psychiatry and the Artificial Heart Program in the division of Cardiothoracic Surgery surveyed LVAD inpatients with a full range of quality of life assessments to determine the effects produced by discharging patients to the home or a home-like environment. Not only did discharged LVAD patients score significantly higher on a myriad of quality of life measures than their hospitalized counterparts, but the discharged patients also improved over their own assessments prior to release from the hospital.
Increasingly lengthy waits for donor hearts have forced doctors and patients alike to begin considering LVADs not simply as short-term bridges to transplantation, but as long-term or even permanent options. In evaluating such alternatives, many feel the "typical" gauges of health are inadequate measures of the implants' long-term success. "The carefully controlled trials in which devices are usually evaluated really report only on a portion of the patient's health. The success of the device must also look to the patient's own quality of life perceptions to gauge their overall health picture," explained Dr. Dew.
Focusing on psychological and psychosocial aspects of patients' well-being, Pitt researchers looked at four demographically similar groups of heart patients: heart transplant recipients, patients not on devices who were waiting for donor hearts at home, and hospitalized and discharged LVAD patients. The study consisted of 35 patients receiving mechanical ventricular assistance at the University of Pittsburgh Medical Center (UPMC), 10 of whom were subsequently discharged, as well as 38 nonhospitalized heart transplant candidates, and 97 heart recipients. Patients were individually interviewed and assessed in four areas: physical functional status, emotional well-being, social functioning, and overall quality of life perceptions.
The results indicated that along with the notable physical recovery exhibited by LVAD patients, upon their discharge similar improvement in all four quality of life areas occurred as well. It was also found that among the four groups surveyed, the non-hospitalized LVAD patients most closely resembled heart transplant recipients in quality of life factors.
"We are very encouraged by the results of this study," explained Dr. Dew, "because it establishes some empirical basis for the development of outpatient programs as safe, routine, and appropriate for LVAD patients." She concluded, "The World Health Organization defines health as -- a state of complete physical, mental, and social well-being and not merely absence of disease or infirmity, "-- using these more "global" health aspects may provide insight into the quality of life consequences of ventricular assist devices and other medical therapies."
In addition to Dr. Dew, other authors of the study include: Robert L. Kormos, M.D.; Stephen Winowich, B.S.Ch.E.; Carla J. Nastala, M.S.N., R.N.; Harvey S. Borovetz, Ph.D.; Loren H. Roth, M.D., M.P.H.; Jorge Sanchez, M.A.; and Bartley P. Griffith, M.D.