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

OBJECTIVES: 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.

DESIGN AND METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.