Follow-up after weaning from temporary mechanical circulatory support: quality of life and psychological impact
L R Roehrich, E Potapov, G Nersesian, N Moessinger, P Kramer, A Matschke, I A Just, L Kopp Fernandes, M Mueller, J Mulzer, S Ott, P Lanmueller, V Falk, F SchoenrathAbstract
Background
Temporary mechanical circulatory support (t-MCS) is a standard-of-care treatment for cardiogenic shock, achieving survival rates of up to 60–70% at discharge (1). Survivors face challenges in recovering from post–intensive care syndrome (PICS) with cognitive, physical, and mental impairments (2). Patients treated with t-MCS may suffer from a distinct PICS-phenotype and could benefit from targeted interventions, but follow-up care data to define the phenotype and guide a structured support remains scarce.
Methods
Between 9/2024 and 9/2025, 257 adult patients underwent t-MCS implantation at a large quaternary cardiogenic shock center. t-MCS weaning was successful in 117 (46%) patients. A follow-up of patients after weaning from t-MCS was conducted by phone after a median of 257 (IQR 155-391) days. Forty (34%) patients agreed to participate in the survey (Impella 5.5 (N = 21 (52 %)), Impella CP (N = 2 (5%)), veno-arterial Extracorporeal Life Support + microaxial flow pump (N = 17 (43 %)). Nine (8%) patients had died after discharge, 4 (3%) declined participation, 59 (51%) were unreachable, and 5 (4%) were excluded due to predefined criteria (2 adults with congenital heart disease, 2 patients were not eligible for informed consent and 1 patient underwent heart transplantation during follow-up). EQ5D-5L and PHQ-9 depression scale were used to screen for psychological consequences and quality-of-life assessment.
Results
Forty patients (male: 32 (80%); age: 63 (IQR 53-66)) suffered from cardiogenic shock due to acute myocardial infarction (N = 13 (32.5%)), worsening heart failure (N = 13 (32.5%)), post-cardiotomy syndrome (N = 7 (17.5%)) or other causes (N = 2 (5%)); protected procedures were conducted in 5 (12.5%) patients. Eleven patients suffered from out- (N =2 (5%)) or in- (N = 9 (22.5%)) hospital cardiac arrest prior to t-MCS implantation. Thirty-seven patients (93%) returned to their pre-event living situation. Median well-being was reported as 60% (IQR 40-80%), 12 (30%) patients reported "no problems" in all five EQ5D-5L domains. Nineteen (47.5 %) patients reported severe problems/inability in at least one domain, mobility emerging as the leading problem (N = 12 (30%)) (Figure 1). Mobility without assistance was possible for 26 (65 %) patients, the self-reported walking distance was 800 m (IQR 60- 1500 m), resp. 1.5 (IQR 0; 3) flights of stairs. According to PHQ-9, 18 (45%) patients expressed moderate to severe symptoms of depression. Near-daily impairment was reported in sleep (N = 12 (27%)), slowness/restlessness (N = 12 (27%)) and fatigue (N = 15 (33 %)) (Figure 2). Thirty (79%) patients would undergo this treatment again to survive.
Conclusion
After t-MCS weaning, patients face significant but addressable declines in activity and quality of life, while the vast majority affirm the life-saving by t-MCS. This underscores the need for structured assessments and tailored interventions after t-MCS weaning during follow-up.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.