Professional employment in patients on ventricular assist device support – a multi-center prevalence study
Christiane Kugler 1, Hannah Spielmann 1, Volker Lauenroth2, Wolfgang Albert 3, Christine Spitz-Köberich 4, Sandra Semmig-Könze5, Paulina Staus6, Katharina Tigges-Limmer2.
1University of Freiburg, Faculty of Medicine, Institute of Nursing Science, Freiburg im Breisgau, Germany; 2Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany; 3German Heart Center Berlin, Berlin, Germany; 4Medical Center – University of Freiburg, University Heart Center Freiburg - Bad Krozingen, Freiburg im Breisgau, Germany; 5Leipzig Heart Center, Leipzig, Germany; 6University of Freiburg, Institute of Medical Biometry and Statistics, Freiburg im Breisgau, Germany
SELMA Study Group.
Background: Ventricular assist device (VAD) implantation aims to support end-stage heart failure patients for the long-term. For patients in productive age ranges, return to an active and productive work life can be seen as a surrogate marker for functional recovery, and psychosocial re-integration. This study aimed to assess professional employment, explore determinants, and the impact of adverse events on professional employment in stable outpatients on ongoing assist device support.
Methods: A national, multi-center study considered rates of professional employment and its relation to sociodemographic (age, gender, education, family), psychosocial (anxiety, depression, quality of life (QoL), and clinical adverse (thromboembolic, bleeding, driveline infection) outcomes in a large sample of 375 stable outpatients on ongoing VAD support. Valid patient-reported outcome measures were administered (WPI, KCCQ, HADS). Retirement age for women (<60yrs), and men (<65yrs) was considered.
Results: The overall sample consisted of 14% (n=53) female patients, mean age for the entire sample being 58±11years, mean time post-implant was 18±11mts, and ranged from 3-36mts. A minority of 15.15% (n=35; 95% CI 10.9-20.6) of the sample were full- or half-time employed. 52.3% (n=196) reported to be unemployed or retired illness-related, and 37.1% (n=139) were retired age-related. For the majority of those working the implant reason was bridge to transplantation 82.9% (n=29), and six patients were bridged to recovery. A regression model after variable selection (R2 Tjur 0.189) revealed younger age (OR 0.95; 95% CI 0.91-0.98; p=0.005), and higher education (OR 3.05; 95% CI 1.72-5.69; p<0.001) to support professional employment. Working patients reported on higher QoL using the KCCQ overall sum-score (OR 1.04; 95% CI 1.01-1.07; p=0.007), and the odds for those working was 2.18 (95% CI 0.89-5.41; p=0.08) indicating no significant relation for working and having had a history of one or more adverse events.
Conclusions: In this national sample, professional employment rates in patients on ongoing VAD support were rather small; however, those employed perceived better overall QoL. Professional employment was not significantly related to clinical adverse events relevant to this population. Future clinical strategies need to be initiated to support psychosocial re-integration in terms of professional employment for patients on VAD support being in the respective age ranges, which may increase patients’ overall QoL perceptions.
