Physiological and Psychological Stress among Left Ventricular Assist Device Patients

Background: Advanced heart failure patients who face end-of-life may require a left ventricular assist device (LVAD) and emotional distress and psychological sequelae have been noted following device insertion. The purpose of this study was to describe physiological and psychological stress and to examine relationships between physiological and psychological stress response and outcomes among LVAD patients. Design: A descriptive observational design was used to describe physiological and psychological stress response among LVAD patients. Methods: Data was collected for patients more than 3 months post-LVAD implantation. Surveys, a Six Minute Walk Test and salivary specimens were collected. Relationships among indicators of stress and outcomes were examined using descriptive statistics and regression models. Results: The overall sample (N = 62) was male (78%), black (47%), and married (66%) with mean age 56.5± 13 years. Normal cortisol awakening response (n = 44) was seen in most participants (62%). There were no differences in cortisol, sleep, psychological stress or outcomes between bridge to transplant and destination therapy patients. However, when comparing the sample by perceived stress level, those with moderate to high perceived stress had worse depression, fatigue and more mal-adaptive coping. Poor sleep quality was correlated with increased psychological stress and QOL (p< 0.01). Regression analysis demonstrated perceived stress and fatigue were significant correlates of overall HRQOL (adj. R2=0.41, p < 0.0001). High social support moderated the relationship between perceived stress and QOL when controlling for fatigue (R2 = 0.49, p< 0.0001). Conclusions: This study reveals important links between physiological and psychological stress response among LVAD patients. The overall sample seemed to have a moderate stress profile: moderate perceived stress, low depressive symptoms and moderate fatigue, with a lot of social support. We did not find differences by implant strategy. In addition, higher perceived stress was related to worse sleep quality, depression, fatigue and mal-adaptive coping. Further, the influence of high levels of social support to improve QOL despite fatigue is confirmation of the need to continually assess the social support available to LVAD patients. Future research should investigate how interventions may be tailored to meet the psychosocial needs of this vulnerable population