Patterns and predictors of dyspnoea following left ventricular assist device implantation.

Aims: Dyspnoea is a common symptom of heart failure (HF) that often prompts patients to seek treatment. Implantation of a left ventricular assist device (LVAD) has been associated with reduced dyspnoea but it is unclear if all patients experience similar improvements in dyspnoea over time following LVAD implantation. Our aim was to identify distinct trajectories of dyspnoea symptoms over time following LVAD implantation and predictors of dyspnoea trajectory.

Exploring gender differences in trajectories of clinical markers and symptoms after left ventricular assist device implantation.

Aims: Despite well-known gender differences in heart failure, it is unknown if clinical markers and symptoms differ between women and men after left ventricular assist device (LVAD) implantation. Our aim was to examine gender differences in trajectories of clinical markers (echocardiographic markers and plasma biomarkers) and symptoms from pre- to post-LVAD implantation.

Methods And Results: This was a secondary analysis of data collected from a study of patients from pre- to 1, 3, and 6 months post-LVAD implantation.

Longitudinal Effects of Left Ventricular Assist Device Implantation on Global and Domain-Specific Cognitive Function.

Background: Left ventricular assist devices (LVADs) are a common treatment of advanced heart failure, but cognitive dysfunction, which is common in heart failure, could limit the ability to perform postimplantation LVAD care. Implantation of an LVAD has been associated with improved cerebral perfusion and may improve cognitive function post implantation.

Objective: The aim of this study was to quantify longitudinal change in cognitive function after LVAD implantation.

Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure.

Background: The relationship between physical and affective symptom clusters in heart failure (HF) is unclear.

Objectives: To identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups.

Methods: This was a secondary analysis of data from two cohort studies among adults with HF.

The role of estrogen, immune function and aging in heart transplant outcomes.

Background: Aging and loss of estrogen suppress immune function, potentially improving survival after orthotopic heart transplant (OHT). The effect of female aging on OHT outcomes is unknown.

Methods: Between 1995 and 2015, 41,299 adult OHT recipients (24.

Development and Initial Validation of the PROMIS®-Plus-HF Profile Measure.

Background Bringing together generic and heart failure (HF)-specific items in a publicly available, patient-reported outcome measure may facilitate routine health status assessment for improving clinical care and shared decision-making, assessing quality of care, evaluating new interventions, and comparing groups with different conditions. Methods and Results We performed a mixed-methods study to develop and validate the PROMIS®-Plus-HF (Patient-Reported Outcomes Measurement Information System®-Plus-Heart Failure) profile measure-a HF-specific instrument based on the generic PROMIS. We conducted 8 focus groups with 61 patients with HF and phone interviews with 10 HF clinicians.

Device-detected congestion is associated with worse patient-reported outcomes in heart failure.

Background: Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms.

Objective: To determine whether device-detected cardiopulmonary congestion is a predictor of physical and psychological symptoms and health-related quality of life (HRQOL) in adults with HF over 3 months.

Heart Failure Symptom Biology in Response to Ventricular Assist Device Implantation.

Background: We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF), particularly in response to left ventricular assist device (LVAD) implantation.

Objective: The aim of this study was to quantify the degree to which symptoms and biomarkers change in parallel from before implantation through the first 6 months after LVAD implantation in advanced HF.

Methods: This was a prospective cohort study of 101 patients receiving an LVAD for the management of advanced HF.

Comparative symptom biochemistry between moderate and advanced heart failure.

Background: We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF).

Objectives: The purpose of this paper was to compare relationships between peripheral biomarkers of HF pathogenesis and physical symptoms between patients with advanced versus moderate HF.

Methods: This was a two-stage phenotype sampling cohort study wherein we examined patients with advanced HF undergoing ventricular assist device implantation in the first stage, and then patients with moderate HF (matched adults with HF not requiring device implantation) in the second stage.

Exploring the relationship between β-adrenergic receptor kinase-1 and physical symptoms in heart failure.

Background: The relationship between physical heart failure (HF) symptoms and pathophysiological mechanisms is unclear.

Objective: To quantify the relationship between plasma β-adrenergic receptor kinase-1 (βARK1) and physical symptoms among adults with HF.

Methods: We performed a secondary analysis of data collected from two studies of adults with HF.

Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy.

Background: 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.

Methods And Results: 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.

Patterns of heart failure symptoms are associated with self-care behaviors over 6 months.

Background: Both heart failure symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time.

Aims: To determine whether patterns of physical symptoms are significantly associated with heart failure self-care over time.

Depressive symptoms in couples living with heart failure: the role of congruent engagement in heart failure management.

Objectives: The life-threatening context of heart failure (HF), high variability of the illness and complexity of care place considerable demands on both the adult patient and his/her spouse. The current study examines the role of congruent engagement in HF management behaviors on the depressive symptoms of the couple living with HF.

Method: A cross-sectional design was used to examine 60 couples living with HF.

Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure.

Background: Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL.

Objective: The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL.

Patterns, relevance and predictors of heart failure dyadic symptom appraisal.

Background: Caregivers are thought to play a major role in helping patients first appraise and then respond to heart failure (HF) symptoms.

Aims: The aims of this study were to: (a) characterise distinct patterns of HF patient-caregiver dyads with respect to symptom appraisal; and (b) link dyadic symptom appraisal to contributions to self-care and caregiver strain.

Methods And Results: A cross-sectional dyadic descriptive design was used to capture patient and caregiver appraisal of patient HF symptoms (i.

The OregonHeart Total Artificial Heart: Design and Performance on a Mock Circulatory Loop.

Widespread use of heart transplantation is limited by the scarcity of donor organs. Total artificial heart (TAH) development has been pursued to address this shortage, especially to treat patients who require biventricular support. We have developed a novel TAH that utilizes a continuously spinning rotor that shuttles between two positions to provide pulsatile, alternating blood flow to the systemic and pulmonary circulations without artificial valves.

Implant Strategy-Specific Changes in Symptoms in Response to Left Ventricular Assist Devices.

Background: Although we know that the quality of life generally improves after left ventricular assist device (LVAD) implantation, we know little about how symptoms change in response to LVAD.

Methods: The purpose of this study was to compare the changes in symptoms between bridge and destination therapy patients as part of a prospective cohort study. Physical (dyspnea and wake disturbances) and affective symptoms (depression and anxiety) were measured before LVAD and at 1, 3, and 6 months after LVAD.

The Role of Dyadic Confidence on Engagement in Heart Failure Care Behaviors.

Background And Objectives: Increasingly, older adults and their families are expected to manage complex conditions with little support. In the case of heart failure (HF), symptom monitoring and management are critical in preventing acute exacerbations and poor clinical outcomes. The current study examined the role of dyadic confidence on engagement in HF care behaviors by patients and their spouses.

Outcomes following implantation of mechanical circulatory support in adults with congenital heart disease: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).

Background: Adults with congenital heart disease represent an expanding and unique population of patients with heart failure (HF) in whom the use of mechanical circulatory support (MCS) has not been characterized. We sought to describe overall use, patient characteristics, and outcomes of MCS in adult congenital heart disease (ACHD).

Methods: All patients entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) between June 23, 2006, and December 31, 2015, were included.

Minimally Invasive LVAD Deactivation in a 65-Year-Old Man with Recurrent Pump Thrombosis and Left Ventricular Recovery.

Pump thrombosis is a dire sequela after left ventricular assist device (LVAD) implantation. Treatment comprises antiplatelet agents, anticoagulants, thrombolytic agents, and pump exchange. Although pump exchange is the definitive therapy, it is also the most invasive, often exposing patients to the risks of repeat sternotomy and cardiopulmonary bypass.

The prevalence of frailty in heart failure: A systematic review and meta-analysis.

Background: There is a growing interest in the intersection of heart failure (HF) and frailty; however, estimates of the prevalence of frailty in HF vary widely. The purpose of this paper was to quantitatively synthesize published literature on the prevalence of frailty in HF and to examine the relationship between study characteristics (i.e.

Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers.

Background: Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device.

Objective: The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation.

Methods: This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads).

Cardiohepatic Interactions: Implications for Management in Advanced Heart Failure.

Liver disease is a common sequela of heart failure and can range from mild reversible liver injury to hepatic fibrosis and, in its most severe form, cardiac cirrhosis. Hepatic fibrosis and cirrhosis due to chronic heart failure have important implications for prognosis, medication management, mechanical circulatory support, and heart transplantation. This article reviews the current understanding of liver disease in heart failure and provides a framework for approaching liver disease in the advanced heart failure population.

Limited Utility of Tricuspid Valve Repair at the Time of Left Ventricular Assist Device Implantation.

Background: The optimal management of tricuspid regurgitation (TR) in patients undergoing left ventricular assist device (LVAD) implantation is controversial. This study was undertaken to determine the impact of tricuspid valve repair (TVR) at the time of LVAD implantation on survival.

Methods: The Interagency Registry for Mechanically Assisted Circulatory Support was used to analyze the outcomes of patients undergoing LVAD implantation as destination therapy with or without concomitant TVR.