27th National Clinical Education Symposium Presentation Abstracts
30 APRIL 2025, WEDNESDAY
10.30-11.45 ORAL PRESENTATION SESSION - 11
Follow-up of Cognitive Functions, Anxiety, Depression and Quality of Life Levels in Heart Failure Patients Planned for Left Ventricular Assist Device Implantation or Heart Transplantation
Göksu Sertcan1, Ozlem Kuman Tuncel1, Sanem Nalbantgil2, Tahir Yagdi33, Cagatay Engin3, Özen Önen Sertöz1
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Show more (Affiliations)
1. Department of Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey
2. Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
3. Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
DOI: 10.5080/kes27.abs99 Page 123-124
BACKGROUND AND AIM:The challenges in the transplantation process have made left ventricular assist devices (LVADs) an important therapeutic option in HF management. In this context, a multidisciplinary approach is crucial. Psychiatric issues such as depression, anxiety, and cognitive impairments, which are frequently observed in HF patients, can negatively impact the course of the disease and complicate treatment adherence. Psychiatry plays a key role in identifying harmful behaviors, providing psychotherapeutic interventions, assessing social support systems, facilitating adherence to treatments like LVAD or transplantation, delivering psychoeducation, and offering supportive interventions when needed. The presence of cognitive function impairments, psychiatric issues such as anxiety and depression, and deteriorations in quality of life in patients with heart failure (HF) has been extensively examined in the literature. However, the findings regarding the changes in these symptoms over time and the effects of treatments such as LVAD on these processes are still limited and inconsistent.This study aims to evaluate and monitor the cognitive functions, quality of life, anxiety, and depression in patients with heart failure who are under follow-up and are planning to undergo left ventricular assist device (LVAD) implantation or heart transplantation by the cardiology or cardiovascular surgery unit. Another objective of the study is to retrospectively identify the medical factors affecting cognitive functions, anxiety, depression, and quality of life during the follow-up period.
METHODS (Ethics Committee Approval must be obtained and the number should be specified.):A total of 37 heart failure patients, who were referred for psychiatric evaluation to the Consultation-Liaison Psychiatry unit for consideration of LVAD implantation or heart transplantation by the cardiology or cardiovascular surgery unit, and who met the inclusion criteria, were included in the study. Of these, 22 patients were followed for six months (initial visit (T0) and 1, 3, and 6 months after the initial visit (T1-T2-T3)), while 12 patients completed the three-month follow-up. Since all 22 patients had threemonth data, the analyses for the three-month follow-up were conducted with a total of 34 patients, and the six-month follow-up analyses were performed with 22 patients. SCID-5 was administered for diagnostic psychiatric assessments at the initial assessment. Self-report scales, including the Hospital Anxiety and Depression Scale (HADS), Short Form 36 (SF-36), Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Multidimensional Scale of Perceived Social Support (MSPSS), were completed by the participants at each follow-up visit. Additionally, the Montreal Cognitive Assessment (MoCA) test was performed at all time points to assess cognitive functions. At the end of the study, all data on the patients' medical and psychiatric conditions over the six-month follow-up period were retrospectively collected from their medical records, and their relationship with the neuropsychological test results was analyzed. In this study, statistical analyses were conducted as follows: Categorical variables were presented as frequencies and percentages, while continuous variables were reported using mean and standard deviation, as well as median with minimum and maximum values. For the comparison of more than two repeated measurements, Repeated Measures ANOVA was employed, and in cases where a significant difference was detected, Bonferroni correction was applied as the post hoc test. The Students t-test was used to compare the means of continuous variables between two independent groups, whereas One-Way ANOVA was conducted for comparisons involving more than two independent groups. To evaluate the interaction between time and LVAD status, Two-Way Repeated Measures ANOVA was applied. The relationships between continuous variables were assessed using Pearsons correlation coefficient. A p-value of <0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics 25.Ethical approval for the study was obtained from the Ethics Committee of Ege University Faculty of Medicine with the decision number 24-3T/75, dated 07.03.2024.
RESULTS:The mean age of our sample was 48.1±12.5 years, with 81.1% being male, 64.9% married. The majority were classified in NYHA stage II and III. The mean ejection fraction was 20.51±8.42%, the 6-minute walk test distance was 386.58±89.74 meters, and peak VO2 was 11.53±3.19 ml/kg/min. At the beginning of the study, it was observed that the mean values of biochemical parameters, except for LDH and direct bilirubin, were within the reference range. At the end of six months, all patients who were approved for LVAD and/or transplantation were listed for transplantation, and 37.1% underwent LVAD implantation. At the initial assessment, 48.6% of patients were diagnosed with a psychiatric disorder according to SCID-5 (27% major depressive disorder, 16.2% anxiety disorder). During the three-month follow-up of 34 patients, no significant changes were observed in the scale scores over time. Similarly, no significant changes were found during the six-month follow-up of 22 patients.Temporal analyses were repeated by grouping patients according to whether they underwent LVAD implantation. In the three-month follow-up, LVAD-implanted patients had lower SF-36 social function and physical role limitation scores at T1 compared to those without LVAD, but this difference disappeared in the subsequent follow-up period. In the six-month follow-up of 22 patients, significant group-time interactions were found in the quality of life scales between the LVAD and non-LVAD groups. This difference was particularly observed at T3. The SF-36 social function scale was similar at both three and six months, but when the LVAD group was evaluated within itself at six months, a significant increase in social function was observed. In the MLHFQ and HADS scores, the non-LVAD group showed almost no change between T0 and T3, while the LVAD group showed a downward trend, although not statistically significant. Similarly, while the scores of the non-LVAD group remained stable over time, the MoCA scores of the LVAD group showed an increasing trend, although no statistically significant group-time interaction was observed. Significant correlations were also found between biochemical parameters and functional capacity indicators with the scales during the follow-up period.
CONCLUSIONS:No patients underwent transplantation during the study period, but those who received LVAD showed better quality of life outcomes at six months compared to those who did not. Although clinical improvements were observed in anxiety, depression levels, and cognitive functions, these improvements did not reach statistical significance. This suggests that larger sample sizes and longer follow-up periods are needed to more clearly demonstrate emotional and cognitive improvements. REFERENCES:1-Aloisi G, Zucchelli A, Aloisi B, Romanelli G, Marengoni A. Depression and heart failure: an intricate relationship. Monaldi Arch Chest Dis. 2019;89(3):10.4081/monaldi.2019.1029. Published 2019 Sep 11 2-Brouwers C, Denollet J, de Jonge N, Caliskan K, Kealy J, Pedersen SS. Patient-reported outcomes in left ventricular assist device therapy: a systematic review and recommendations for clinical research and practice. 3-Connors EJ, Hauson AO, Barlet BD, et al. Neuropsychological Assessment and Screening in Heart Failure: a Meta-Analysis and Systematic Review. Neuropsychol Rev. 2021;31(2):312-330 4-Davis KK, Allen JK. Identifying cognitive impairment in heart failure: a review of screening measures. Heart Lung. 2013;42(2):92-97 5-Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443