Date Presented 03/23/24
Managing a left ventricular assist device (LVAD) requires complicated activity demands, yet there is no evidence on predictors of independence with device management. This study determined predictors of LVAD self-management and advocates for the role OTPs have on the work-up team.
Primary Author and Speaker: Kellie Cannone
Additional Authors and Speakers: Jessica Asiello, Christina M. Kelley
Contributing Authors: John Wong, Lauren McInnis, Abigail Begin, Marissa Dittrich, Erin E. Donovan, Kimberly Beatty, Nicole C. Lam, Alyssa M. Taubert
BACKGROUND: From 2012-21 27,314 U.S. adults received a left ventricular assist device (LVAD) (Yuzefpolskaya et al., 2023). Managing an LVAD is complex and essential to prevent adverse health outcomes and increase engagement in life activities (Barsuk et al., 2020; Kato et al., 2014). No evidence describes predictors of independence with LVAD management.
OBJECTIVE: Determine predictors of LVAD self-management.
METHOD: A prospective cohort study occurred at a U.S. LVAD center. OTs evaluate LVAD candidates pre-operatively as the standard of care. The evaluation measures cognition via Montreal Cognitive Assessment (MoCA), functional cognition via Allen Cognitive Level Screen (ACLS), grip strength (GS) normalized by height (kg/m2), daily activity performance via Activity Measure for Post Acute Care (AM-PAC), and LVAD battery management via performance-based screen. Kendall’s tau-b correlations examined relationships between pre-operative assessments and post-operative LVAD management and pre-operative OT predictions and post-operative LVAD management. Binary logistic regression with forward LR examined the effect of pre-operative variables on post-operative LVAD management.
RESULTS: 72 LVAD recipients from 2019-23 were assessed by OT both pre- and post-operatively. OTs’ pre-operative predictions were significantly associated with actual post-operative level of assistance with LVAD management (r=.435, p=.000). GS was a significant predictor of independence with LVAD management (β=.149, p=.004) while the ACLS approached statistical significance (β=.168, p=.054). The ACLS was a significant predictor of 24/7 supervision/assistance with LVAD management (β=-.181, p=.006).
CONCLUSIONS: Pre-operative OT predictions were associated with actual post-operative LVAD management. GS and ACLS were the most predictive assessments.
IMPACT: Knowing what predicts LVAD self-management helps OTPs prognosticate patients’ needs post-implantation- a vital consideration for the continuum of care.
References
Barsuk, J. H. M., Cohen, E. R. Me., Harap, R. S. B., Grady, K. L., Wilcox, J. E. M., Shanklin, K. B. M., Wayne, D. B., & Cameron, K. A. (2020). Patient, caregiver, and clinician perceptions of ventricular assist device self-care education inform the development of a simulation-based mastery learning curriculum. Journal of Cardiovascular Nursing, 35(1), 54–65. https://doi.org/10.1097/JCN.0000000000000621
Kato, N., Jaarsma, T., & Ben Gal, T. (2014). Learning self-care after left ventricular assist device implantation. Current Heart Failure Reports, 11(3), 290–298. https://doi.org/10.1007/s11897-014-0201-0
Yuzefpolskaya, M., Schroeder, S. E., Houston, B. A., Robinson, M. R., Gosev, I., Reyentovich, A., Koehl, D., Cantor, R., Jorde, U. P., Kirklin, J. K., Pagani, F. D., & D’Alessandro, D. A. (2023). The Society of Thoracic Surgeons Intermacs 2022 Annual Report: Focus on the 2018 Heart Transplant Allocation System. The Annals of Thoracic Surgery, 115(2), 311–327. https://doi.org/10.1016/j.athoracsur.2022.11.023
