A Left Ventricular Assist Device

A Left Ventricular Assist Device (LVAD) is a major cardiac surgery with many postoperative complications. Not only is an LVAD a significant surgery, but it also requires a lifestyle change outside of the hospital. Patients with LVADs will either be put on a heart transplant list, or the implantation of an LVAD may be the last resort for end-stage congestive heart failure. Accepting such changes and understanding the prognosis can be difficult for patients, both mentally and physically. A few complications of LVAD surgeries include, but are not limited to, respiratory decompensation and infection.

"The rates of LVAD-related infections are high, ranging from 30 to 50%" (Jezovnik, et al., 2017). If depression among LVAD patients contributes to increased infection and other complications, the rate of complications may decrease. The advanced practice nurse's goal is to identify potential causes of complications postoperatively and take action to prevent them.

Purpose

Advanced Practice Nurses have the responsibility to stay up to date with evidence-based practice research to deliver the best care for patients. Nurse Practitioners will determine PICO clinical questions and examine multiple sources of research to answer PICO questions (Steward & DeNisco, 2019). If there is a positive correlation between the BDI score and postoperative complications, healthcare professionals can look for early signs of depression and help treat it, to assist in LVAD recovery. Advanced Practice Nurses must seek out contributing factors, based on evidence-based practice, that are hindering patient progress. If depression leads to decreased respiratory status, increased length of stay in the ICU, slow progress with rehabilitation/physical therapy, and increased postoperative infection, it's the Advanced Practice Nurse's responsibility to address this concern. Early recognition of depression could lead to better outcomes for postoperative LVAD patients.

PICOT Question

Do 6-week, postoperative LVAD patients with Beck Depression Inventory (BDI) scores of 19 or higher have a higher instance of postoperative complications, such as respiratory status, physical therapy progression, and infection, than patients who have BDI scores of 18 or lower?

Databases

Scholarly articles are important in evidence-based research and can be found on appropriate databases. PubMed is a government database that has information such as "biomedical literature from MEDLINE, life science journals, and online books" (PubMed, n.d.). CINAHL (2018) is a database that includes journals specific to nursing and allied healthcare. EBSCO Health (2018) is a database that provides evidence-based research for nursing and research tools by searching multiple healthcare databases. The Cochrane Library (2018) is a database that provides "independent evidence" in healthcare research by focusing on systematic reviews. ClinicalTrials.gov (2018) is a "database of privately and publicly funded clinical studies conducted around the world". Nurse practitioners can use a variety of databases to find accurate, up-to-date, evidence-based information to provide the best care for their patients.

EBP for PICOT question

A research study (Yost, et al., 2017) examined the Beck Depression Inventory Scores (BDI), Beck Anxiety Inventory Scores (BAI), and heart failure markers in pre- and post-LVAD implantation surgery. The results showed that the BDI and BAI scores, along with heart failure markers, decreased post-LVAD implantation. This might suggest that depression and anxiety are reduced when heart failure symptoms decrease. Another study utilized a systematic review and meta-analysis of articles involving patients with LVADs for destination therapy (DT) and bridge to transplant (BTT) related to LVAD outcomes (McIlvennan, et al., 2014). The findings reported enhanced overall quality of life, yet they also emphasized the prevalence of many common complications of LVAD placement and a surge in hospitalization rates post-op.

Role of the Nurse Practitioner

Conclusion

Early indications of depression among LVAD patients could be a crucial aspect in the acute phase of recovery (6-weeks post-op). Using the Beck Depression Inventory Score will give clinicians an indicator that a patient may be showing signs of depression, which could ultimately lead to postoperative complications. Treatment of depression before and after LVAD implantation could reduce complications, including infection rate, physical therapy progression, and respiratory decompensation. Advanced Care Practitioners play an important role in identifying depression among LVAD patients and enacting a plan to help the patients cope with the lifelong change of having an LVAD.

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