Cardiac assist devices: Cognitive and behavioral factors among patients awaiting cardiac transplantation.

摘要

Cognitive functioning and quality of life are salient factors in predicting mortality and morbidity in end-stage heart failure patients receiving cardiac assist devices while awaiting cardiac transplantation. This study focused on cognitive functioning and self-reported quality of life, neurological impairment, and depressive symptoms. Of 103 candidates for cardiac assist devices (HeartMate ThermoCardio systems, Inc. [TCI] Left Ventricular Devices [LVAD] or Abiomed Biventricular Assist System [Abiomed]) as a bridge to cardiac transplantation at Hahnemann University Hospital, a total of 53 patients completed neuropsychological evaluations. Cognitive factors included visual-spatial and verbal memories, motor speed, grip strength, and cognitive processing speed. In addition, a total of 298 end-stage heart failure (ESHF) inpatients completed the same cognitive measures over the past decade. Overall, cognitive functioning for both groups was within the normal range. Not surprisingly, a series of t-tests revealed that ESHF inpatients performed better than MCAD candidates on most cognitive measures. However, MCAD candidates performed better than ESHF inpatients on the Mental Status Exam, Visual Reproduction Immediate subtest of the Wechsler Memory Scale, and grip strength task with the nondominant hand.; A total of 23 cardiac assist device candidates completed self-report measures of general and disease-specific quality of life, depressive symptoms, memory, and self reported neuropsychological symptoms. Results did not support the hypothesis that depression would mediate the relationship between cognitive functioning and quality of life. There were significant differences in quality of life between the three groups: ESHF, MCAD, and OHT warranting a discussion of the implications of various definitions of quality of life. There were no significant gender differences. Major behavioral findings were (1) these patients are resilient in comparison to the general population; their cognitive functioning was not impaired and they were not depressed and (2) there was a strong relationship between self-report depressive symptoms and self-reported neurological impairment.