A qualitative study of the psychological experience of patients during and after mechanical cardiac support

Treatments for end-stage heart failure include medical therapy, heart transplantation, and, more recently, implantation of a ventricular support assist device (VAD). Little is known about the psychological adjustment and quality of life of these patients and how patients with a VAD in situ compare with those who underwent transplantation or had the device explanted.

A cross-sectional study using grounded theory methodology was carried out. Patients with heart failure living with a VAD and those who underwent transplantation or explantation were interviewed to elicit perceptions of their adjustment and quality of life.

All patients identified perceived control as their core category, with 3 related conceptual categories: normality, uncertainty, and emotional state. Identity of illness/VAD and the impact of the device were specifically identified by VAD patients, and independence was identified by transplant patients.

This study has identified previously unrecognized concepts in the adjustment of patients with either a VAD in situ or who have had the device explanted or have undergone transplantation. It provides a basis for the development of specific nursing and psychological care designed to support this developing surgical practice.