Task Force 4: Inpatient Management of Patients with MCSD - The ...

may also be related to the type of MCS device. For example, BiVADs may affect
independence from a “lifestyle” perspective, as patients are tethered to a machine or
must use a driver on a wheeled cart. As a result, these patients are less able to
function independently. In contrast, patients with LVADs who are discharged with a
“wearable system” carry the external components in a fanny pack. 52 Finally,
psychosocial support may be indicated for patients and families while learning to
manage and troubleshoot the MCSD, if they have concerns about their knowledge of
MCS, lack confidence in MCSD management, or become overwhelmed. 51
There is also evidence in the literature regarding psychological sequelae early
after MCS implantation. Anxiety, lack of control over one’s life, and depression have
been reported in hospitalized patients after MCS implantation. 53-55 Patients have also
reported moderate levels of stress related to having advanced heart failure, being
hospitalized and away from family, the need for MCS, and post-operative pain. 54
Uncertainty may also be an important factor causing stress, especially for “bridge to
candidacy” patients. Furthermore, family distress also requires monitoring and
intervention. Psychiatric symptoms may predict nonadherence to the medical regimen,
unhealthy lifestyle (including substance abuse), poor medical outcomes, and poor
health related quality of life after discharge. 51
Despite the stress associated with hospitalization for MCS, patients have also
generally reported that they were coping fairly well, although not as well as their selfreport
of overall coping prior to surgery. 54 At 2 weeks after MCS (while still
hospitalized), patients used more positive coping styles (e.g., optimistic, self-reliant, and
supportant) than negative coping styles (e.g., fatalistic, evasive, and emotive), and
positive coping was more effective than negative coping. 54 Importantly, psychological
assessment and intervention is needed for patients who use negative coping strategies.
Interestingly, at both 2 weeks and 1 month after surgery (while still hospitalized), the
vast majority of BTT patients reported no regret regarding having undergone MCS
implantation, citing that the MCS saved their lives. 54,55 This “honeymoon phase” may be
related to relief regarding surviving surgery, denial, and not considering the demands of
self-care, prognosis (especially for DT patients), and the possible complications of MCS
(e.g., stroke) on lifestyle and long-term quality of life. 51,54,55 It is important to note that
17