Caregiver burden highest immediately after LVAD placement

A study of 50 sets of patients and caregivers suggests the first month after left ventricular assist device (LVAD) implantation is when the patient’s quality of life improves the most—but also when the caregiver is under the most stress.

The study, published March 7 in the Journal of the American Heart Association, is one of the first to assess how patient-caregiver relationships may influence outcomes in this population.

“As cardiologists using heart pumps to support this extremely sick group of heart failure patients, we sometimes neglect the impact of our therapies on caregivers and families,” said JAHA editor-in-chief Barry London, MD, PhD, the director of cardiovascular medicine at the University of Iowa Carver College of Medicine. “This clearly shows how these advanced therapies affect caregivers, and that the relationship of the patients to their caregivers can alter outcomes.”

Lead researcher Julie T. Bidwell, PhD, RN, and colleagues analyzed data for severity of heart failure and perceptions of the caregiver-patient relationship before LVAD implantation, as well as questionnaires subjectively assessing quality of life and caregiver strain both preprocedure and at one month, three months and six months post-operation.

Patient quality of life was assessed on a scale of 0 to 100 using the Kansas City Cardiomyopathy Questionnaire. On average, it improved from 29.6 before LVAD placement to 51.3 one month afterward. Smaller gains to 61.5 and 63 were captured at three and six months, respectively.

Total caregiver strain was measured on a scale of 18 to 90. Caregivers reported an average strain of 37 pre-operation, 40.6 at one month, 40.5 at three months and a return to 37 at six months.

The researchers found time constraints, a compromised social life and physical strain were the top three sources of caregiver stress.

“This suggests that strain in LVAD caregivers may be partly ameliorated by advocating for respite, home care, or other services that might provide caregivers with time and support to attend to other obligations, maintain a healthy social life, practice better self‐care, and protect their own physical health,” Bidwell et al. wrote. “More important, the trajectory of strain in this study demonstrates that these services may be necessary and appropriate not only in the early postoperative period, but for at least six months postoperatively and likely beyond.”

Bidwell et al. also found the type of relationship was important to caregiver strain and patient recovery patterns. Specifically, patients with nonspousal caregivers had a worsening quality of life from one to six months post-LVAD implantation, in contrast to those with spousal caregivers. On the other hand, caregivers who were married to the LVAD recipient had higher levels of caregiver burden before the procedure.

“Strain pre‐implantation may be heightened by the threat of losing a partner and/or the added burden of caring for someone who was previously able to contribute to household responsibilities,” the researchers wrote. “For patients, long‐term QOL (quality of life) may suffer because nonspousal caregivers, who were less likely to live with the patient before implantation but almost exclusively lived with the patient up through six months post‐implantation, may be stretched by the unexpected demands of an extended caregiving role; thus, they may possibly reduce caregiving contributions for practical or emotional reasons.”

Bidwell and colleagues suggested relationship type should be examined further in future studies. In addition, they said the small sample size of their study, its single-center design and the fact that most patients were white males and their caregivers were female spouses limits the generalizability of the results.