Symptom Frequency and Severity over Time for Patients Undergoing LVAD Implantation

K. L. Grady, K. Wortman, B. Ruo, J. J. Teuteberg, J. Lindenfeld, J. D. Rich, C. W. Yancy, D. Pham, C. K. McIlvennan, L. Allen, M. S. Kiernan, D. Beiser, C. M. Murks, L. Klein, C. S. Lee, Q. Denfeld, M. Walsh, D. Cella, S. Buono, P. CummingsM. Kallen, E. A. Hahn

Research output: Contribution to journalArticle

Abstract

PURPOSE: Patients (pts) with advanced heart failure (HF) describe debilitating HF-related symptoms. Those who undergo left ventricular assist device (LVAD) implantation report new surgical and device-related symptoms. We sought to quantify change in both HF and LVAD-related symptoms over time. METHODS: Using a longitudinal design, we evaluated data at baseline, 3, and 6 months (mos) post implant at 9 U.S. sites from 10/26/16 - 9/9/19. Measures assessed HF symptoms: fatigue (PROMIS, v1.0), dyspnea (10-item short form), swelling in extremities, abdominal bloating, poor appetite (single items), and LVAD-related symptoms: severity of pain at driveline exit site and chest incision, severity of discomfort wearing LVAD peripherals, and frequency of dizziness and fluid leaking around driveline exit site (single items). Linear mixed effects models were estimated using all available longitudinal data, assuming a missing at random mechanism. RESULTS: Pts (n=126) were primarily male (72%) and non-Hispanic White (62%), with mean age= 55±11.7 years. HF symptoms (i.e., fatigue, dyspnea, extremity swelling, abdominal bloating, and poor appetite) decreased from before to after implant (table). From 3-6 months after LVAD implant, severity of driveline exit site pain was none-mild and did not change; severity of chest incision pain was mild and decreased from 3 to 6 months; discomfort wearing peripherals was mild-moderate with no change, dizziness occurred rarely to occasionally and did not change, and fluid leaking at the driveline exit site occurred never to rarely and did not change (table). CONCLUSION: Using novel measures, pts with advanced HF experienced considerable improvement of HF symptoms after LVAD implant. However, pts also reported mild/moderate discomfort wearing LVAD-related peripherals, which did not change over time. Other LVAD-related symptoms were less frequent or no more than mild in severity. These findings provide important information for pt decision making and should guide device design.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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