Self-care practice among patients after the implantation of a left ventricular assist device
S Melnikov, M Eriksson-Liebon, M Endo, A Stromberg, M Ono, M Hatano, T Jaarsma, T Ben-Gal, N KatoAbstract
Background
Left ventricular assist devices (LVADs) are increasingly used worldwide for patients with advanced heart failure (HF). Successful long-term LVAD support requires high levels of patient self-care, encompassing LVAD-specific tasks and general HF self-care. However, evidence on self-care behaviour and its associated factors in different healthcare contexts remains limited.
Aim
To describe self-care behaviour among patients supported with an LVAD in Israel and Japan and to identify factors associated with self-care behaviours.
Methods
A cross-sectional survey was conducted among adults with an LVAD who were attending outpatient clinics at two university hospitals in Israel and Japan. Data collection took place between 2016 and 2021. Self-care behaviours were assessed using the 20-item LVAD Self-Care Behaviour Scale 1), comprising of monitoring, HF self-care, and LVAD self-care subscales. Each item on the 5-point scale was dichotomized, with scores of 1–2 classified as poor self-care and scores of 3–5 classified as good self-care. Total and subscale scores were standardized to a range from 0 to 100, with higher scores indicating better self-care. Clinical and socio-demographic data were obtained from questionnaires and medical records. Univariate analyses and multiple linear regression models were used to identify factors associated with self-care behaviours.
Results
Data from 117 patients (52 from Israel and 65 from Japan) were analysed. Mean age was 50 ± 14 years and 83% were male. Nineteen patients (16%) were actively employed in a full-time or part-time and were not on sick leave. Most patients (92%) were supported with an LVAD as a bridge to transplant. The median duration of LVAD support was 272 days (IQR, 116-594), and 42 % had been living with an LVAD for over one year. Overall self-care behaviour was high, with more than 90% of participants reporting good performance in 18 self-care behaviours. The total score of the LVAD self-care scale was 87.2±9.4. Subscale scores for monitoring, HF self-care, and LVAD self-care were 89.6±13.7, 76.5±15.8, 92.1±9.5 respectively. Multiple linear regression analysis showed that having a bridge-to-transplant indication (standard partial regression coefficients, sβ=0.19, p=0.03) and living with an LVAD for more than one year (sβ=-0.32, p<0.01) were both associated with poor HF self-care behaviours. Furthermore, compared with patients from Japan, patients from Israel had a significantly poorer self-care monitoring (sβ=0.28, p<0.01). In addition, being employed either full-time or part time was independently associated with poorer LVAD-specific self-care (sβ=-0.20, p=0.03).
Conclusions
Overall LVAD self-care was high. Country of residence, employment status, LVAD indication, and duration of support influenced self-care engagement. Tailored, long-term, and context-sensitive self-care interventions are needed for patients with these factors associated with poor self-care.