Social Connections and Depressive Symptoms in Heart Failure

Introduction: There are no instruments that measure health-related quality of life (HRQOL) after mechanical circulatory support (MCS). As part of our MCS HRQOL instrument development research project, we report on two domains of HRQOL: physical function/role performance and social interaction/support.Methods:We conducted semi-structured interviews with 24 MCS patients (125bridge to transplant [BTT] and 125destination therapy [DT]) both early and later after implant. Interviews lasted 30-60 minutes and were audio-recorded and transcribed verbatim. Using qualitative methodology, data were analyzed using a 2-phase coding strategy. Results: As heart failure symptoms abate post MCS, patients gradually increase their physical function, mobility, and ambulation. Some patients described MCS as cumbersome and interfering with functional activities (requiring stooping down and bending over) and basic activities of daily living (dressing, showering, and toileting). After hospital discharge, they re-introduced more active home management and leisure activities, although they identified hassles and limitations with resumption of more strenuous activities (e.g., mowing the lawn, handyman work, gardening, and bicycling). Resumption of work and sexual intimacy were identified as particularly challenging, and life span issues influenced expectations and satisfaction with limitations in these areas. Adaptation to MCS self-care increased over time; carrying equipment was a hassle and related to neck and back discomfort. Social interaction after discharge was influenced by pre-morbid habits, expectations, and adaptability (e.g., more planning needed to go out and need for a caregiver). Most patients were satisfied with support of MCS self-care; although some patients identified caregivers as being too overprotective and desired more privacy. Patients typically felt useful, but also often perceived themselves to be a burden on their families. Conclusions: The early post-MCS implant period is one of tremendous physical and social adjustment. Over time, MCS patients increase physical activities and social interaction, while acknowledging hassles and limitations related to MCS. These data will inform development of an instrument to measure MCS HRQOL.