This study empirically evaluates the quality of life (QOL) effects associated with hospital discharge among heart transplant candidates whose lives are maintained by left ventricular support systems (LVAS). Thirty-five LVAS inpatients (18 Novacor, 17 Thoratec) received structured QOL assessments approximately 1 month after device implant. Ten of the patients (8 Novacor, 2 Thoratec) were subsequently discharged to either home or a home-like outpatient facility where their QOL was reassessed. The QOL of LVAS patients, before and after discharge, was compared with that of demographically similar nonhospitalized heart transplant candidates (n = 55) and recipients (n = 97). Their caregivers' QOL was also assessed. The QOL of LVAS outpatients showed statistically significant (p<0.05) advantages over remaining LVAS inpatients and nonhospitalized heart candidates. Advantages appeared in physical, emotional, and social functioning domains. The QOL of LVAS outpatients also improved (p<0.05) over their own QOL before discharge, with the greatest change in physical functional and emotional status. The QOL of LVAS outpatients most closely resembled QOL in the transplant recipients. Family caregivers to LVAS outpatients reported some increases in caregiving burden after patient discharge, but their overall well being was not adversely affected. These data provide an empiric basis for the provision of outpatient programs as appropriate care for eligible LVAS patients.

Activities of Daily Living↗

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Patterns and predictors of risk for depressive and anxiety-related disorders during the first three years after heart transplantation.

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Adaptation, Psychological↗

PubMedDate not supplied

Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation.

Although poor psychological adjustment to organ transplantation appears to be a major contributor to reduced quality of life and increased physical morbidity, the prevalence and risk factors for psychiatric disorder have not been considered beyond the first 12-18 months after transplantation. The authors enrolled a representative sample of 191 heart transplant recipients in a prospective examination of the prevalence, clinical characteristics, and risk factors for DSM-III-R major depressive disorder (MDD), generalized anxiety disorder (GAD), associated adjustment disorders, and posttraumatic stress disorder related to transplant (PTSD-T) during the 3 years postsurgery. Survival analysis indicates that cumulative risks for disorder onset were MDD, 25.5%; adjustment disorders, 20.8% (17.7% with anxious mood); PTSD-T, 17.0%; and any assessed disorder, 38.3%. There was only one case of GAD. PTSD-T onset was limited almost exclusively to the first year posttransplant. Episodes of MDD (but not anxiety disorders) that occurred later posttransplant (8 to 36 months postsurgery) were more likely than early posttransplant episodes to be treated with psychotropic medications. For both MDD and anxiety disorders, later episodes were less likely to be precipitated by transplant-related stressors than other life stressors. Factors increasing cumulative risk for psychiatric disorder posttransplant included pretransplant psychiatric history, female gender, longer hospitalization, more impaired physical functional status, and lower social supports from caregiver and family in the perioperative period. Risk factors' effects were additive; the presence of an increasing number of risk factors bore a dose-response relationship to cumulative risk of disorder.

Adolescent↗

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The dental team in a mental hospital facility.

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Delivery of Health Care↗

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Life quality in the era of bridging to cardiac transplantation. Bridge patients in an outpatient setting.

This study provides an empirical evaluation of quality of life in the first two heart transplant candidates with mechanical circulatory support who were transferred (with support in place) to an outpatient setting to await transplantation. Their life quality in physical, emotional, and social domains following transfer was compared to: 1) their previous life quality while hospitalized, 2) life quality among a case series of five other candidates awaiting transplantation during the same time period, and 3) life quality among recent samples of heart recipients from our center and elsewhere. The transferred patients improved markedly in physical and emotional well being, with smaller gains in social functioning after leaving the hospital. They not only improved over their own earlier status while hospitalized, but showed life quality advantages over other hospitalized transplant candidates. Overall, they came to more closely resemble transplant recipients, rather than candidates, of similar age and indication for transplant. Outpatient care for selected mechanically supported heart transplant candidates provides an important potential option for the increasing numbers of patients requiring such support for extended time periods. The study yields critical data as fully implantable mechanical circulatory support devices for permanent heart replacement become a possibility.

Adolescent↗