Evolving Paradigms in Home Left Ventricular Assist Device Therapy　― Reducing Caregiver Burden in the Era of Advanced Technology ―

Abstract

Background: In Japan, caregiver presence 24 h/day, 7 days a week is required for patients with left ventricular assist devices (LVADs) during the first 6 months after discharge, with ongoing cohabitation recommended thereafter. This study evaluated the incidence of LVAD pump stoppages during home care, the role of caregivers in preventing adverse events, and the need for continuous caregiver support.

Methods and Results: A retrospective analysis was conducted on 264 patients who underwent LVAD implantation between 2010 and 2023 and were managed at home. In all, 116 power loss incidents were documented, with 65 leading to pump stoppages. Notably, no stoppages occurred in patients using the EVAHEART or HeartMate 3 devices, which are equipped with backup battery systems. Of the 65 stoppages, 83% were resolved by patients and only 6% required caregiver intervention. The Zarit Burden Interview revealed a mean caregiver burden score of 30.1, comparable to that of caregivers for patients with severe brain damage.

Conclusions: The burden experienced by caregivers of LVAD patients is substantial, but with the advent of advanced devices like the HeartMate 3, the need for caregiver support 24 h/day, 7 days a week may be reconsidered. The findings of this study suggest that continuous caregiver presence may not be essential for all LVAD patients, potentially easing the burden on caregivers.