Oregon Health and Science University School of Nursing, Portland, OR
Oregon Health and Science University School of Nursing, Portland, OR.
J Am Heart Assoc. 2018 Mar 7;7(6):e008080. doi: 10.1161/JAHA.117.008080.
Although current guidelines emphasize the importance of social support to the success of left ventricular assist device (LVAD) therapy, few studies examine the influence of the caregiver on patient outcomes or quantify the impact of LVAD caregiving on caregiver outcomes. The purpose of this analysis was to identify patient and caregiver determinants of patient quality of life (QOL) and caregiver strain in response to LVAD therapy.
Data on patients receiving LVAD therapy and their caregivers (n=50 dyads) were prospectively collected pre-implantation and 1, 3, and 6 months post-implantation. Growth curve modeling was used to describe change in patient QOL (Kansas City Cardiomyopathy Questionnaire) and caregiver strain (Multidimensional Caregiver Strain Index). Patient QOL improved most in the first month (β=23.22±3.76, <0.001), followed by gradual gains over 6 months (β=1.90±0.64, <0.01). Caregivers experienced worsening of strain in the first month (β=4.30±1.42, <0.01), followed by gradual resolution to pre-implantation levels by 6 months (β=-0.71±0.23, <0.01). Worse pre-implantation patient symptoms were associated with greater improvement in patient QOL (β=0.53±0.19, <0.01) but worsening caregiver strain (β=0.15±0.07, =0.04). Better relationship quality was associated with greater improvement in patient QOL (β=14.39±5.85, =0.01) and less pre-implantation caregiver strain (β=-9.31±2.28, <0.001). Nonspousal caregivers experienced less pre-implantation strain (β=-8.60±3.10, =0.01), and patients with nonspousal caregivers had less improvement in QOL (β=-3.70±1.62, =0.02).
A combination of patient and caregiver characteristics predicts patient and caregiver response to LVAD therapy. Including caregiver factors in future studies may be helpful in developing interventions that improve patient and caregiver outcomes, together.
尽管目前的指南强调了社会支持对左心室辅助装置（LVAD）治疗成功的重要性，但很少有研究探讨照顾者对患者结局的影响，或量化 LVAD 护理对照顾者结局的影响。本分析的目的是确定患者和照顾者决定因素，以响应 LVAD 治疗的患者生活质量（QOL）和照顾者压力。
前瞻性收集了接受 LVAD 治疗的患者及其照顾者（n=50 对）的数据，分别在植入前、植入后 1、3 和 6 个月收集。使用增长曲线模型描述患者 QOL（堪萨斯城心肌病问卷）和照顾者压力（多维照顾者压力指数）的变化。患者 QOL 在第一个月改善最多（β=23.22±3.76，<0.001），然后在 6 个月内逐渐增加（β=1.90±0.64，<0.01）。照顾者在第一个月经历了压力的恶化（β=4.30±1.42，<0.01），然后在 6 个月内逐渐恢复到植入前的水平（β=-0.71±0.23，<0.01）。植入前患者症状越严重，患者 QOL 的改善越大（β=0.53±0.19，<0.01），但照顾者压力恶化越大（β=0.15±0.07，=0.04）。更好的关系质量与患者 QOL 的更大改善（β=14.39±5.85，=0.01）和植入前照顾者压力的减少（β=-9.31±2.28，<0.001）相关。非配偶照顾者在植入前的压力较小（β=-8.60±3.10，=0.01），而非配偶照顾者的患者 QOL 改善较少（β=-3.70±1.62，=0.02）。
患者和照顾者的特征组合预测了患者和照顾者对 LVAD 治疗的反应。在未来的研究中纳入照顾者因素可能有助于共同改善患者和照顾者的结局。
