LV assist devices weaken sexual function but improve independence, socialization

Using left ventricular assist devices (LVAD) in both the short- and long-term impairs health-related quality of life (HRQoL) and sexual function, but improves their social interactions and independence, according to a recent study.

“This study provides new insights into the HRQoL of patients supported with LVADs. The novelty of this study is in its integrative approach aiming to capture the various HRQoL aspects at different time intervals after implantation,” the researchers said.

Using the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), HRQoL was assessed in 46 LVAD patients (median age, 66 years, 11 percent women) who had had their implants for a median of 1.1 years at the time of survey. The Changes in Sexual Functioning Questionnaire (CSFQ) was also administered. Data were collected at baseline, as well as at the 6- and 12-month follow-ups.

At baseline the median KCCQ-12 score was 56. Over the study duration, improvements were detected in the Questionnaire’s symptom frequency domain, while scores in the physical limitation and QoL domains grew worse. [ESC Heart Fail 2021;doi:10.1002/ehf2.13282]

Dividing the sample according to duration of LVAD support (<1 vs ≥1 year) revealed no difference in KCCQ-12 scores. Pearson analysis also showed no link between KCCQ-12 and device use duration (p=0.812). A prior history of LVAD-related complication likewise did not correlate with KCCQ-12.

In addition, significant impairments were observed in sexual functioning. The baseline median CSFQ summary score was 31, indicative of overall sexual dysfunction. This effect was observed across all domains of the CSFQ and remained true even when disaggregating according to device use duration. There was also no correlation between LVAD duration and sexual dysfunction (p=0.328).

Over time, and using each patient’s baseline as their own control, the researchers saw a significant decline in CSFQ summary scores, indicative of worsening sexual function (p<0.001). Most patients (58 percent) reported that the device severely interfered with their sexual enjoyment, and 77 percent said they had not been given sexual consultations before implantation.

Nevertheless, the device implant brought patients significant functional benefits, too. Majority (87 percent) of recipients felt that LVADs did not pose a limitation to driving, and 76 percent of those who drove before the procedure resumed afterward.

Moreover, 57 percent of recipients reported being able to travel domestically, either for business or pleasure, though 27 percent actively refrained from going abroad. Seventy-eight percent agreed that LVADs either did not or only minimally limited their travelling experience. The implant likewise did not interfere with socialization, leisure, and employment in many of the participants.

“Consultation and education that capture the whole spectrum of ‘living with an LVAD,’ including social interactions, driving, and sexual function should be integrated into the pre-LVAD implantation assessment and preparation, thus allowing a better-informed decision of the patient and his caregiver,” the researchers said.

“Further study and expert consensus recommendations should focus on the development of LVAD-specific HRQoL instrument, which should be based on patient-reported outcomes,” they added.