Self-care behaviors of patients with implanted left-ventricular assist device in Israel: a comparative study before and during COVID-19 pandemic
Authors: Melnikov S , Jaarsma T , Yaari V , Abuhazira M , Ben Avraham B , Itzhaki O , Shaul A , Ben Gal T 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Left ventricular assist devices (LVADs) support the heart of patients with advanced heart failure. Following LVAD implantation, patients face a complex regimen of self-care behaviors including self-care maintenance, self-care monitoring and self-care management. During the COVID-19 pandemic, the self-care might be inadequate because of the disease occurrence as well as social constraints, transportation restrictions, social distancing, and psychosocial stress. Little is known on how comparable specific self-care behaviors are among LVAD-implanted patients before and during COVID-19 pandemic.

Purpose
To describe and compare self-care behaviors among patients with an implanted LVAD in Israel before and during the COVID-19 pandemic and explore factors related to self-care behaviors change.

Methods
A prospective observational cross-sectional study design. A convenience sample of 28 Israeli LVAD-implanted patients (mean age 62.4 ± 9, 86% male, 78.6% lived with a partner) completed an LVAD Self-Care Behavior Scale before (data collection: March, 2017- February, 2020) and again, following the onset of COVID-19 pandemic in Israel in March 2020 (data collection: April, 2020 – September, 2020). The patients responded to 33 statements about how they perform self-care behaviors on a 5-point Likert scale ranging from 1 (never) to 5 (always). Statistical analyses included paired t-test and one-way repeated measures ANOVA.

Results
Attending scheduled clinic visits (M=4.93) and keeping the exit site and the driveline clean and dry (4.89) were two highly prevalent behaviors that did not change during the COVID-19 pandemic. The significant decrease in adherence during the COVID-19 pandemic was found in checking and recording LVAD speed, flow, power and PI (Mbefore=3.88±1.48 vs Mduring=3.08±1.55, t=2.02, p=.05), checking INR (Mb=5.0±0 vs Md=4.78±.42, t=2.73, p=.01), and weighing daily (Mb=4.54±.71 vs Md=3.92±1.06, t=3.19, p&lt;.01). Adherence to the following behaviors increased most prominently, but not statistically significantly: talking to an LVAD team when feeling sad or worried (Mb=3.13±1.65 vs Md=3.71±1.55, t=1.39, p=.18) and contacting the LVAD team in case of symptoms (Mb=4.52±.96 vs Md=4.80±.5, t=1.37, p=.18).
Compared to patients with a partner, those without a partner tended to worsen their adherence to some of the self-care behaviors e.g. taking medicines as prescribed (Mb=5.00±0 and Md=5.0±0 vs Mb=5.0±0 and Md=4.6±.89, F=4.85, p=.04, respectively).

Conclusions
Priorities in self-care behaviors among patients with implanted LVAD may differ before and during a pandemic. In several crucial behaviors in self-care maintenance and management (checking and recording LVAD and INR, and taking medicines) and self-care monitoring (daily weighing) the adherence decreased significantly. The current results may guide further research on identifying behaviors at risk of not being maintained in a time of emergency.