Modica Maddalena, Ferratini Maurizio, Torri Anna, Oliva Fabrizio, Martinelli Luigi, De Maria Renata, Frigerio Maria
Cardiac Rehabilitation S. Maria Nascente, IRCCS Fondazione Don Gnocchi, Milan, Italy.
Artif Organs. 2015 Mar;39(3):220-7. doi: 10.1111/aor.12362. Epub 2014 Sep 10.
Patients who temporarily or permanently rely on left ventricular assist devices (LVADs) for end-stage heart failure face complex psychological, emotional, and relational problems. We conducted a mixed-method study to investigate quality of life, psychological symptoms, and emotional and cognitive reactions after LVAD implant. Twenty-six patients admitted to cardiac rehabilitation were administered quality of life questionnaires (Short Form 36 of the Medical Outcomes Study and Minnesota Living with Heart Failure Questionnaire), the Hospital Anxiety and Depression Scale, and the Coping Orientation for Problem Experiences inventory, and underwent three in-depth unstructured interviews within 2 months after LVAD implant. Quality of life assessment (Short Form 36) documented persistently low physical scores whereas mental component scores almost achieved normative values. Clinically relevant depression and anxiety were observed in 18 and 18% of patients, respectively; avoidant coping scores correlated significantly with both depression and anxiety (Pearson correlation coefficients 0.732, P < 0.001 and 0.764, P < 0.001, respectively). From qualitative interviews, factors that impacted on LVAD acceptance included: device type, disease experience during transplant waiting, nature of the assisted organ, quality of patient-doctor communication, the opportunity of sharing the experience, and recipient's psychological characteristics. Quality of life improves early after LVAD implant, but emotional distress may remain high. A multidimensional approach that takes into account patients' psychological characteristics should be pursued to enhance LVAD acceptance.
因终末期心力衰竭而暂时或永久依赖左心室辅助装置（LVAD）的患者面临着复杂的心理、情绪和人际关系问题。我们开展了一项混合方法研究，以调查LVAD植入后的生活质量、心理症状以及情绪和认知反应。对26名接受心脏康复治疗的患者进行了生活质量问卷调查（医学结局研究简表36和明尼苏达心力衰竭生活问卷）、医院焦虑抑郁量表以及问题经历应对取向量表，并在LVAD植入后2个月内进行了三次深入的非结构化访谈。生活质量评估（简表36）显示身体得分持续较低，而心理成分得分几乎达到正常水平。分别有18%和18%的患者观察到具有临床意义的抑郁和焦虑；回避应对得分与抑郁和焦虑均显著相关（皮尔逊相关系数分别为0.732，P < 0.001和0.764，P < 0.001）。从定性访谈中得出，影响LVAD接受度的因素包括：装置类型、移植等待期间的疾病经历、辅助器官的性质、医患沟通质量、分享经历的机会以及接受者的心理特征。LVAD植入后早期生活质量有所改善，但情绪困扰可能仍然较高。应采用一种考虑患者心理特征的多维方法来提高LVAD的接受度。
