Skip to main content
SpringerLink
Log in

Psychosocial Considerations of Mechanical Circulatory Support: Decision Making, Behavioral Evaluation, Quality of Life, Caregivers, and End of Life

  • Chapter
  • First Online:
Mechanical Circulatory Support in End-Stage Heart Failure

Abstract

An understanding of the tenets of medical ethics and related fundamentals of medical decision making and communication is critical to the optimal implantation, maintenance, and discontinuation of long-term mechanical circulatory support (MCS). Shared decision making incorporates the perspective of the patient, who is responsible for articulating values, goals, and preferences as they relate to his or her healthcare. For patients with advanced heart failure who are considering the option of MCS, understanding benefits, risks, burdens of available options, and outcomes (survival and health-related quality of life [HRQOL]) and changes in lifestyle, implications for caregivers, and potential for withdrawal of MCS are critical to successful implantation, within the context of patient values, preferences, and goals. An ethical process fully engages patients, their families, and the advanced heart failure team and supports the potential for successful decision making and enhanced outcomes. The purpose of this chapter is to discuss decision making and informed consent, psychosocial and behavioral evaluation prior to surgery, HRQOL outcomes, caregiver burden, and palliative care/end-of-life care for patients who undergo long-term MCS implantation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BTT:

Bridge to transplant

DT:

Destination therapy

HRQOL:

Health-related quality of life

INTERMACS:

Interagency Registry for Mechanically Assisted Circulatory Support

MCS:

Mechanical circulatory support

NYHA:

New York Heart Association

References

  1. Hall DE, Prochazka AV, Fink AS (2012) Informed consent for clinical treatment. Can Med Assoc J 184:533–540

    Article  Google Scholar 

  2. Allen LA, Stevenson LW, Grady KL, Goldstein NE, Matlock DD, Arnold RM, Cook NR, Felker GM, Francis GS, Hauptman PJ, Havranek EP, Krumholz HM, Mancini D, Riegel B, Spertus JA (2012) Decision making in advanced heart failure: a scientific statement from the American Heart Association. Circulation 125:1928–1952

    Article  PubMed  PubMed Central  Google Scholar 

  3. Institute of Medicine Committee on Quality of Health Care in America (2001) Crossing the quality chasm: a new health system for the 21st century. National Acadamy Press, Washington, DC

    Google Scholar 

  4. McIlvennan CK, Magid KH, Ambardekar AV, Thompson JS, Matlock DD, Allen LA (2014) Clinical outcomes after continuous-flow left ventricular assist device: a systematic review. Circ Heart Fail 7:1003–1013

    Article  PubMed  PubMed Central  Google Scholar 

  5. McIlvennan CK, Allen LA, Nowels C, Brieke A, Cleveland JC, Matlock DD (2014) Decision making for destination therapy left ventricular assist devices: “there was no choice” versus “I thought about it an awful lot.”. Circ Cardiovasc Qual Outcomes 7:374–380

    Article  PubMed  PubMed Central  Google Scholar 

  6. Iacovetto MC, Matlock DD, McIlvennan CK et al (2014) Educational resources for patients considering a left ventricular assist device: a cross-sectional review of Internet, print, and multimedia materials. Circ Cardiovasc Qual Outcomes 7:905–911

    Article  PubMed  Google Scholar 

  7. Curtis JR, Engelberg RA, Nielsen EL, Au DH, Patrick DL (2004) Patient-physician communication about end-of-life care for patients with severe COPD. Eur Respir J 24:200–205

    Article  CAS  PubMed  Google Scholar 

  8. Bruce CR, Delgado E, Kostick K, Grogan S, Ashrith G, Trachtenberg B, Blumenthal-Barby JS (2014) Ventricular assist devices: A review of psychosocial risk factors and their impact on outcomes. J Card Fail 20:996–1003

    Article  PubMed  Google Scholar 

  9. Maltby M, Flattery MP, Burns B, Salyer J, Weinland S, Shah KB (2014) Psychosocial assessment of candidates and risk classification of patients considered for durable mechanical circulatory support. J Heart Lung Transplant 33:836–841

    Article  PubMed  Google Scholar 

  10. Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P (2005) Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis 178:339–344

    Article  CAS  PubMed  Google Scholar 

  11. Grenard JL, Munjas BA, Adams JL, Suttorp M, Maglinone M, McGlynn EA, Gellad MF (2011) Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med 26:1175–1182

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tully PJ, Baune BT, Baker RA (2013) Cognitive impairment before and six months after cardiac surgery increase mortality risk at median 11 year follow-up: a cohort study. Int J Cardiol 168:2796–2802

    Article  PubMed  Google Scholar 

  13. Cameron J, Worrall-Carter L, Page K, Riegel B, Kai Lo S, Stewart S (2010) Does cognitive impairment predict poor self-care in patients with heart failure. Eur J Heart Fail 12:508–515

    Article  PubMed  Google Scholar 

  14. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Chertkow H (2005) The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699

    Article  PubMed  Google Scholar 

  15. Blinderman C, Homel P, Billings A, Portenoy R, Tennstedt S (2008) Symptom distress and quality of life in patients with advanced congestive heart failure. J Pain Symptom Manage 35:594–603

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kirklin JK, Naftel DN, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Miller MA, Baldwin JT, Young JB (2014) Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant 33:555–564

    Article  PubMed  Google Scholar 

  17. Grady KL, Naftel D, Myers S et al (2015) Change in health-related quality of life from before to after destination therapy mechanical circulatory support is similar for older and younger patients: analyses from INTERMACS. J Heart Lung Transplant 34:213–221

    Article  PubMed  Google Scholar 

  18. Estep JD, Starling RC, Horstmanshof DA et al (2015) Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients. J Am Coll Cardiol 66(16):1747–1761

    Article  PubMed  Google Scholar 

  19. Grady KL, Naftel D, Stevenson L et al (2014) Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation. J Heart Lung Transplant 33(4):412–421

    Article  PubMed  Google Scholar 

  20. Grady KL, Magasi S, Hahn E et al (2015) Health-related quality of life in mechanical circulatory support: Development of a new conceptual model and items for self-administration. J Heart Lung Transplant 34:1292–1304

    Article  PubMed  Google Scholar 

  21. Grady KL, Naftel DC, Myers SL et al (2015) Pre and post operative factors related to change in HRQOL from before to 6 months following LVAD implantation: an INTERMACS analysis. J Heart Lung Transplant 34(4S):S75

    Article  Google Scholar 

  22. Wissman S, Naftel DC, Myers SL et al (2015) Health-related quality of life improves dramatically from pre implant to post implant (6 months) for continuous flow LVAD patients in INTERMACS. J Heart Lung Transplant 34(4S):S75–S76

    Article  Google Scholar 

  23. Bunzel B, Laederach-Hofmann K, Wieselthaler G, Roethy W, Wolner E (2010) Mechanical circulatory support as a bridge to heart transplantation: what remains? Long-term emotional sequelae in patients and spouses. J Heart Lung Transplant 26:384–389

    Article  Google Scholar 

  24. Kaan A, Young QR, Cockell S, Mackay M (2010) Emotional experiences of caregivers of patients with a ventricular assist device. Prog Transplant 20:142–147

    Article  PubMed  Google Scholar 

  25. Marcuccilli L, Casida JM (2011) From insiders’ perspectives: adjusting to caregiving for patients with left ventricular assist devices. Prog Transplant 21:137–143

    Article  PubMed  Google Scholar 

  26. Adelman RD, Tmanova L, Delgado D, Dion S, Lachs MS (2014) Caregiver Burden. A clinical review. JAMA 311:1052–1059

    Article  CAS  PubMed  Google Scholar 

  27. Fang JC, Ewald GA, Allen LA, Butler J, Westlake Canary CA, Colvin-Adams M, Dickinson MG, Levy P, Stough WG, Sweitzer NK, Teerlink JR, Whellan DJ, Albert NM, Krishnamani R, Rich MW, Walsh MN, Bonnell MR, Carson PE, Chan MC, Dries DL, Hernandez AF, Hershberger RE, Katz SD, Moore S, Rodgers JE, Rogers JG, Vest AR, Givertz MM (2015 Jun) Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee. J Card Fail 21(6):519–534

    Article  PubMed  Google Scholar 

  28. Fendler TJ, Swetz KM, Allen LA (2015) Team-based palliative and end-of-life care for heart failure. Heart Fail Clin 11(3):479–498

    Article  PubMed  PubMed Central  Google Scholar 

  29. Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care-creating a more sustainable model. N Engl J Med 368(13):1173–1175

    Article  CAS  PubMed  Google Scholar 

  30. Swetz K, Ottenberg AL, Freeman MR, Mueller PS (2011) Palliative care and end-of-life issues in patients treated with left ventricular assist devices as destination therapy. Curr Heart Fail Rep 8:212–218

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Surgery and Department of Medicine Feinberg School of Medicine, Chicago, IL, USA

    Kathleen L. Grady PhD, RN, MS

  2. Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, 201 E. Huron Street, Galter Pavilion, 11-140, Chicago, IL, 60611, USA

    Kathleen L. Grady PhD, RN, MS

  3. Section of Advanced Heart Failure, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA

    Larry A. Allen MD, MHS

  4. Division of Cardiac Surgery, Department of Surgery and Department of Psychiatry Feinberg School of Medicine, Chicago, IL, USA

    Paul W. Goetz PhD

Authors
  1. Kathleen L. Grady PhD, RN, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larry A. Allen MD, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul W. Goetz PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen L. Grady PhD, RN, MS .

Editor information

Editors and Affiliations

  1. San Camillo-Forlanini Hospital, Rome, Italy

    Andrea Montalto

  2. Cardiac Surgery, S.Orsola-Malpighi Hospital, Bologna, Italy

    Antonio Loforte

  3. San Camillo-Forlanini Hospital, Rome, Italy

    Francesco Musumeci

  4. Deutsches Herzzentrum Berlin, Berlin, Germany

    Thomas Krabatsch

  5. Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA

    Mark S. Slaughter

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Grady, K.L., Allen, L.A., Goetz, P.W. (2017). Psychosocial Considerations of Mechanical Circulatory Support: Decision Making, Behavioral Evaluation, Quality of Life, Caregivers, and End of Life. In: Montalto, A., Loforte, A., Musumeci, F., Krabatsch, T., Slaughter, M. (eds) Mechanical Circulatory Support in End-Stage Heart Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-43383-7_45

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43383-7_45

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43381-3

  • Online ISBN: 978-3-319-43383-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation