Association of pre-left ventricular assist device defibrillator shocks for ventricular arrhythmia with clinical outcomes after left ventricular assist device implantation.

Background: Implantable cardioverter-defibrillation (ICD) shocks after left ventricular assist device therapy (LVAD) are associated with adverse clinical outcomes. Little is known about the association of pre-LVAD ICD shocks on post-LVAD clinical outcomes and whether LVAD therapy affects the prevalence of ICD shocks. Objectives: The purpose of this study was to determine whether pre-LVAD ICD shocks are associated with adverse clinical outcomes post-LVAD and to compare the prevalence of ICD shocks before and after LVAD therapy. Methods: Patients 18 years or older with continuous-flow LVADs and ICDs were retrospectively identified within the University of Pittsburgh Medical Center system from 2006-2020. We analyzed the association between appropriate ICD shocks within 1 year pre-LVAD with a primary composite outcome of death, stroke, and pump thrombosis and secondary outcomes of post-LVAD ICD shocks and ICD shock hospitalizations. Results: Among 309 individuals, average age was 57 ± 12 years, 87% were male, 80% had ischemic cardiomyopathy, and 42% were bridge to transplantation. Seventy-one patients (23%) experienced pre-LVAD shocks, and 69 (22%) experienced post-LVAD shocks. The overall prevalence of shocks pre-LVAD and post-LVAD were not different. Pre-LVAD ICD shocks were not associated with the composite outcome. Pre-LVAD ICD shocks were found to predict post-LVAD shocks (hazard ratio [HR] 5.7; 95% confidence interval [CI] 3.42-9.48; P <.0001) and hospitalizations related to ICD shocks from ventricular arrhythmia (HR 10.34; 95% CI 4.1-25.7; P <.0001). Conclusion: Pre-LVAD ICD shocks predicted post-LVAD ICD shocks and hospitalizations but were not associated with the composite outcome of death, pump thrombosis, or stroke at 1 year. The prevalence of appropriate ICD shocks was similar before and after LVAD implantation in the entire cohort.

Assessment of caregiver burden prior to implantation of left ventricular assist device: A national survey.

BACKGROUND: Guidelines recommend incorporation of caregiver burden assessment and list significant caregiver burden as a relative contraindication when considering left-ventricular assist device (LVAD) implantation. METHODS: To assess national practices regarding caregiver burden assessment, in 2019 we administered a 47-item survey to LVAD clinicians using 4 convenience samples. RESULTS: Responses were obtained from 191 registered nurses, 109 advance practice providers, 71 physicians, 59 social workers, and 40 others representing 132 LVAD programs; 125 of 173 total United States programs were included in the final analysis. While most programs (83.2%) assessed caregiver burden, assessment was most frequently conducted informally during social work evaluation (83.2%), with only 8.8% incorporating validated measures of caregiver burden. Larger programs were more likely to use a validated assessment measure (OR 6.68 [1.33-33.52]). CONCLUSIONS: Future research should focus on how programs can standardize caregiver burden assessment and how the level of burden may impact patient and caregiver outcomes.

Does education modify the association between depression and cardiovascular health? (from the National Health and Nutritional Examination Survey, 2013-14 and 2015-16).

Study objective: Depression and education have associations with cardiovascular health. We hypothesized educational attainment would modify the association between depression and cardiovascular health. Design: We used the Patient Health Questionnaire (PHQ), a validated instrument to categorize individuals as having minimal (0-4), moderate (5-9) or severe (≥10) depression. We employed the American Heart Association's Life's Simple 7 (LS7) comprised of known cardiovascular risk factors. In multivariable-adjusted analyses we related PHQ to cardiovascular health measured by LS7. We then evaluated the modification of the association between depression and cardiovascular health by educational attainment. Participants: Individuals age ≥18 years participating in the National Health and Nutrition Examination Survey 2013-214 and 2015-16 cycles. Main outcome measures: LS7, continuous (0-14) and categorized as poor (0-4), intermediate (5-9) or ideal (10-14). Results: In total 8727 individuals (age 48 ± 17 years; 51% female sex; 70% white race; 14% < high school graduate; 32% ≥ college graduate) were included. Among those with mild depression, educational attainment greater than a high school degree or equivalent was significantly more likely to have higher LS7 scores than those without high school graduation. In participants with moderate depression, only those with college education or greater were more likely to have higher LS7 scores (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.01-6.08). In those with severe depression, educational attainment did not modify LS7 scores. Conclusions: Our findings suggest that educational attainment modifies the association between depression and cardiovascular health. This study provides insight on how social factors modify depression, a well-recognized contributor to cardiovascular health.