Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy
BackgroundAlthough 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 thi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.008080 |
| _version_ | 1818775938458976256 |
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| author | Julie T. Bidwell Karen S. Lyons James O. Mudd Kathleen L. Grady Jill M. Gelow Shirin O. Hiatt Christopher V. Chien Christopher S. Lee |
| author_facet | Julie T. Bidwell Karen S. Lyons James O. Mudd Kathleen L. Grady Jill M. Gelow Shirin O. Hiatt Christopher V. Chien Christopher S. Lee |
| author_sort | Julie T. Bidwell |
| collection | DOAJ |
| description | BackgroundAlthough 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 ResultsData 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). ConclusionsA 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. |
| first_indexed | 2024-12-18T11:04:59Z |
| format | Article |
| id | doaj.art-6c1c07df4d984e4884e1f4be170b3b3d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T11:04:59Z |
| publishDate | 2018-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6c1c07df4d984e4884e1f4be170b3b3d2022-12-21T21:10:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-03-017610.1161/JAHA.117.008080Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device TherapyJulie T. Bidwell0Karen S. Lyons1James O. Mudd2Kathleen L. Grady3Jill M. Gelow4Shirin O. Hiatt5Christopher V. Chien6Christopher S. Lee7Oregon Health and Science University School of Nursing, Portland, OROregon Health and Science University School of Nursing, Portland, OROregon Health and Science University Knight Cardiovascular Institute, Portland, ORNorthwestern University Feinberg School of Medicine, Chicago, ILOregon Health and Science University Knight Cardiovascular Institute, Portland, OROregon Health and Science University School of Nursing, Portland, ORUniversity of North Carolina REX Healthcare, Raleigh, NCOregon Health and Science University School of Nursing, Portland, ORBackgroundAlthough 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 ResultsData 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). ConclusionsA 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.https://www.ahajournals.org/doi/10.1161/JAHA.117.008080caregiversheart failurequality of lifeventricular assist device |
| spellingShingle | Julie T. Bidwell Karen S. Lyons James O. Mudd Kathleen L. Grady Jill M. Gelow Shirin O. Hiatt Christopher V. Chien Christopher S. Lee Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease caregivers heart failure quality of life ventricular assist device |
| title | Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy |
| title_full | Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy |
| title_fullStr | Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy |
| title_full_unstemmed | Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy |
| title_short | Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy |
| title_sort | patient and caregiver determinants of patient quality of life and caregiver strain in left ventricular assist device therapy |
| topic | caregivers heart failure quality of life ventricular assist device |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.008080 |
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