Adaptation and coping in patients living with an LVAD: A metasynthesis

Abstract

Objective: To synthesize information supporting coping and adaptation of LVAD patients and to identify opportunities for future interventions.

Background: Left Ventricular Assist Device (LVAD) patients demonstrate improvements in quality of life and functional status, but qualitative research has not been meaningfully integrated.

Methods: Qualitative meta-synthesis using Lazarus and Folkmans' Transactional Model of stress and coping.

Results: Four distinct stages of adaptation were identified: Pre-LVAD, Implant Hospitalization, Early Home Adaptation and Late Home Adaptation. Each stage includes tasks in physical, psychological and social domains. Two themes emerged: 1) Primary Appraisal: Every stage is a new challenge and 2) Secondary Appraisal: Routines are achievable, emotions are more difficult.

Conclusions: Emotional challenges including fear and anxiety related to life-limiting illness and changed social roles need to be honestly addressed. Individuals living with LVAD achieve a sense of independence, enjoy social interactions and meaningful activities through addressing practical and emotional problems to facilitate coping.

Keywords: Adaptation; Coping; Heart failure; LVAD; Left Ventricular Assist Device.