Adherence to Self-Care Behaviors after Left Ventricular Assist Device Implantation

Benjamin Ben Avraham Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Sackler School of Medicine, Tel Aviv University, Israel Naoko P Kato Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Tiny Jaarsma Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Victoria Yaari Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Sackler School of Medicine, Tel Aviv University, Israel Miriam Abu-Hazeira Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Sackler School of Medicine, Tel Aviv University, Israel Dimitry Golobov Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Sackler School of Medicine, Tel Aviv University, Israel Anna Strömberg Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Tuvia Ben Gal Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Sackler School of Medicine, Tel Aviv University, Israel

Purpose: Performing self-care is vital for the long term success of left ventricular assist device (LVAD) implantation. We aimed at describing the adherence to self-care behaviors among patients living at home with an LVAD.

Methods: A cross-sectional study with a self-administered questionnaire was performed between March and April 2017 in Rabin Medical Center, Israel. This 33-item questionnaire was developed through a narrative literature review and Delphi rounds with experts. Patients were asked to answer if they performed these items on a 5 point scale: 1 ‘never’ and 5 ‘always’. Items cover behavior related to self-care: maintenance, monitoring and management. Answers were dichotomized (1-3= low and 4-5= good adherence)

Results: Data from 18 patients was analyzed (age 62±10 years, male 89%). Eight Patients were supported with HeartMate III (44%), 5 with HeartWare (28%) and 5 with HeartMateII (28%). Fourteen patients were implanted as BTT (78%) and 4 as DT (22%). The median period on LVAD support was 550 days (Q1-Q3; 246-1118). Five patients had poor adherence in more than 9 items. Adherence to the 33 self-care behavior items ranged from 6% to 100%. Top 5 items all patients reported to always adhere were: checking the power, keeping the exits site clean, checking INR, taking medications and monitoring for worsening fatigue. The 5 items with the lowest adherence were: measuring blood pressure (5.6% of good adherence, the mean score 1.7±1.1), exercise regularly (28%, 2.7±1.1), checking the LVAD speed and flow (39%, 3.1±1.7), talking with the LVAD team or someone when I am feeling sad or worried (44%, 2.8±1.7) and weighing myself every day (55%, 3.6±1.2),

Conclusions: Not all self-care behaviors that are deemed as important by health care providers and literature were performed by LVAD patients. Successful interventions to improve adherence to important self-care behaviors need to be developed, tested and implemented.

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Tuvia Ben Gal

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