Quality of Life and Left Ventricular Assist Device Support

More than 5 million Americans are living with heart failure, with an additional 500 000 cases diagnosed each year.1 Ongoing improvements in patient management will only increase the number of patients surviving to develop severe refractory heart failure (stage D). Approximately 5% to 10% of all heart failure patients are classified as stage D and defined as patients who continue to have symptoms of dyspnea or fatigue at rest despite optimal medical management.2 Mechanical circulatory support (MCS) is an advanced surgical therapy for the treatment of stage D heart failure.2 Last year, >1500 patients in the United States were implanted with a left ventricular assist device (LVAD), an implantable system that supports the failing left ventricle.3 Implantation of an LVAD is an effective strategy to prolong survival and to improve the quality of life (QOL) of patients living with stage D heart failure. The indications for LVAD support include bridge to recovery (BTR), bridge to transplantation (BTT), or destination therapy (DT). The purpose of this article is to discuss QOL for patients supported on an LVAD. The discussion begins with an overview of QOL and how it is measured, followed by an in-depth review of QOL results in patients supported on an LVAD. QOL is a subjective evaluation that reflects a person's overall appraisal of how happy, satisfied, and content he or she is with life. It differs from person to person on the basis of that person's life experience, expectations, attitudes, values, and beliefs. Here, we define QOL as a person's perception of the impact of a disease or treatment on her/his life.4 QOL is a multidimensional concept and includes aspects of physical, mental, and social functioning. Because it is a subjective evaluation, it cannot be measured directly. QOL can be measured indirectly with …