ed the first fully mechanical heart . However , researchers ’ focus soon shifted to the creation of single-chamber pumps to offer cardiac support , and that heralded the era of ventricular assist devices . With each generation of device ; size , noise , and infection rates were curtailed ( Prinzing et al ., 2016 ). LVADs are expected to improve survival , functional capacity , and the quality of life and thereby reduce the surging costs of health care due to heart failure .
A retrospective multicenter study was conducted between 2005 and 2010 . The sample size consisted of 156 subjects . Patients were followed up for a mean duration of 5.2 years . The primary finding of the study was that among LVAD patients surviving four years or longer , mean survival was 7.1 years ; these patients continue to have the high functional capacity , with most characterized as NYHA functional class 1 or 11 . A randomized controlled study was done in 2001 investigating long-term use of pulsatile LVAD for end-stage heart failure . The sample group consisted of 129 patients . This group was subdivided into two groups . The first , consisting of 68 patients , was treated with LVAD ; the second group , consisting of 61 patients , was treated medically . Rates of survival were significantly higher in the LVAD group ( 52 %) compared to the medical group ( 25 %) ( Prinzing et al ., 2016 ). Another prospective study demonstrated that LVAD therapy was associated with improvement in the quality of life and functional capacity ( Gosev et al ., 2018 ). These data further support the use of LVADs to treat heart arrhythmia complications such as ventricular tachycardia .
Cardiac rehabilitation helps patients by improving their quality of life as well as maintaining cardiac functional capacity . Physical exercises , such as running , improve maximal oxygen intake ( VO2 ), thus reducing heart failure symptoms and decreasing all causes of hospitalization and mortality . However , there are few studies describing exercise training in patients with LVADs . Kerrigan et al . ( 2014 ) conducted a single-blind experiment that demonstrated improved muscle strength and cardio-respiratory fitness . A 17 % increase in peak leg torque was observed with post-exercise training program in those patients . A 14.4 % increase in the Kansas City Cardiomyopathy Questionnaire ( KCCQ ) score , a quality improvement score , was observed in patients with LVAD . Another study that was conducted by Rogers et al . ( 2009 ) concluded that continuous use of LVAD in advanced heart failure patients resulted in clinically relevant improvements in functional capacity and heart failure-related quality of life . The patients ’ quality of life was assessed using Minnesota Living with Heart Failure Questionnaire ( MLWHF ) and the Kansas City Cardiomyopathy Questionnaire ( KCCQ ). These study results demonstrate the positive impacts of LVADs as a viable treatment option to improve outcomes while decreasing the cost .
However , the use of these devices presents numerous health care challenges that can lead to re-hospitalization . Some experts have stated that the highest cases of re-admissions are linked to gastro-intestinal ( GI ) bleeding and infections related to the continuous flow of the LVAD ( CF-LVAD ). However , a study conducted by Akhter et al . ( 2015 ) investigated planned and unplanned hospital readmission rates following LVAD implantation , overall survival , and the costs associated with each hospital admission . The results indicated that patients with LVAD spent 93 % of their time out of hospital after implantation and readmissions did not hinder long-term survival ( Akhter et al ., 2015 ). Moreover , their research confirmed that the most common causes of readmissions were GI bleed and CF-LVAD-related infections . The median cost of a single readmission was $ 7,546 and the median time to first readmission was 35 days ( Akhter et al ., 2015 ). Kilgore , Patel , Kielhorn , Maya , and Sharma ( 2017 ) demonstrated that the mean cost per patient with a heart failure hospitalization was $ 14,631 among Medicare beneficiaries in 2017 , and approximately 25 % of patients with heart failure were readmitted within a month . Therefore , our health care system needs new strategies that will increase the efficiency of the LVADs while decreasing the cost associated with post- LVAD implantation therapy .
Among patients , advanced heart failure is associated with an increased incidence of depression and anxiety . According to Allen et al . ( 2010 ), LVAD placement has demonstrated significant effective strategies that can help in mitigating these heart-related comorbidities by producing a better quality of life ( Allen et al ., 2010 ). LVAD placement has demonstrated significant improvement in patients ’ quality of life and emotional wellbeing within a few months . Mapelli et al . ( 2014 ) argues that resuming social activities ( such as work and intimacy ) contributes to rebuilding self-esteem and confidence . Depression is common in patients suffering from congestive heart failure and has been associated with increased morbidity and mortality .
Multiple studies have assessed the quality of life with LVAD placements . Our patient health questionnaire-9 ( PHQ-9 ) has been validated to measure depressive symptoms in a patient with heart failure , but it does not measure general health problems . Moreover , Severin , Sabbahi , Ozemek , Phillips , and Arena ( 2019 ) have observed that even though the aforementioned devices continue to receive praise , they are not effective in improving hemodynamic status . Therefore , many patients in end-stage HF still possess peripheral pathological adaptations . Extensive research should be done to discover and update LVADs to improve the general health outcomes of patients .
Conclusion
Left ventricular assist devices are now acceptable alternative treatment modalities in end-stage heart failure . This case study describes a patient ’ s changes in functional capacity , improvement in depression , emotional wellbeing , and tolerance to physical exercises after undergoing an LVAD placement . LVADs are effective therapeutic tools that can improve the quality of health in heart failure patients and non-candidates for heart transplant . Despite numerous challenges experienced with these therapies , the authors suggest further outcome studies in the field of LVADs that consider physical , emotional and psychological factors .
212 • The Journal of the Arkansas Medical Society www . ArkMed . org