Preliminary report on left-ventricular assist devices: are patients' and caregivers' psychosocial needs adequately addressed?

Patients implanted with a Left Ventricular Assist Device (LVAD) constitute a new population of chronic heart failure (HF) patients requiring continuous medical support and representing heavy costs - both direct and indirect - for the healthcare system. If there is consensus about the increased survival, the psychosocial outcomes, in terms of psychological wellbeing, behavioral and social functioning of both patients and caregivers, are still unclear. Overall, it is not clear if local health and social services are equipped to support them in their needs. We conducted an observational study on the psychosocial characteristics and needs of LVAD patients. Twenty-seven patients admitted for rehabilitation after implantation, and their caregivers were recruited. On admission, patients and caregivers were administered questionnaires assessing anxiety, depression, quality of life, level of social complexity and were interviewed about their social resources. At discharge, patients were re-assessed by questionnaires and patients/caregivers received a follow-up phone-interview after 8-12 months. LVAD patients' emotional well-being and subjective quality of life improved during the rehabilitation stay and they confirmed their satisfaction with LVAD at follow-up. Problems emerged concerning the inadequate health and social assistance that LVAD patients receive once home. More than 50% of patients showed substantial social complexity, the burden of which fell on the caregivers, whose strain hardly declined over time, remaining at a level requiring psychological attention. Technological advances that improve LVAD patients' survival should be rapidly followed by adequate interventions by policy makers to improve also the local health/social assistance provided and to address patients and caregivers psychosocial needs over time.