Quality of life outcomes after heart transplantation in individuals bridged to transplant with ventricular assist devices

Background: Increasing numbers of individuals receive ventricular assist de vices (VADs) as bridges to heart transplantation. Physical morbidity risks and benefits, and quality of life (QOL) during VAD support have been docume nted. Effects of pretransplant VAD support on functional and QOL outcomes a fter transplantation have received no empirical attention. Methods: Sixty-three VAD patients who received heart transplants underwent QOL evaluations of physical functioning, emotional and cognitive well-being , and social functioning at 2, 7, and 12 months after transplant (response rate = 95%). Ninety patients who had not received VADs-matched to the VAD g roup on cardiac-related and socio demographic characteristics-served as lon gitudinal controls. Results: Both VAD and non-VAD groups showed similar levels and similar, sta tistically significant (p < 0.05) improvement in physical functioning (slee p, body care, mobility, ambulation, overall functional status, number of so matic complaints) across the study period. Emotional well-being (elevated d epressive, anxiety, and anger symptoms; post-traumatic stress disorder rate ) was stable or improved in both groups, and VAD patients showed significan tly lower anxiety rates. The VAD patients' posttransplant cognitive status was significantly poorer. The VAD patients were significantly less likely t o return to employment; other social functioning measurers (daily concerns, interpersonal activities/involvement, role function) showed mixed effects. Cognitive impairment explained much of the association between VAD support and posttransplant employment. Conclusions: Although post-transplant physical and emotional recovery is si milar in VAD and non-VAD patients, VAD patients retain more cognitive impai rment and show mixed changes in social functioning. Increased attention to strategies to maximize VAD patients' cognitive capacity is required to faci litate social reintegration.