Supportive psychotherapy for patients with heart transplantation or ventricular assist devices

Abstract

Objective: Both heart transplant (HTX) candidates and patients on ventricular assist device (VAD) support suffer from severe heart failure and have to fear life-threatening complications. For both patient groups, the importance of screening for and treatment of psychosocial problems and mental disorders to optimize compliance and survival has been acknowledged. We compared the use of psychotherapeutic support by patients with primary HTX, on VAD support, either on destination therapy or to be transplanted, and successfully bridged to transplant. In addition, we evaluated the use for supportive psychotherapy for the families of our patients and present two typical cases.

Methods: Patients with primary HTX (HTX(prim), n=16), with VAD on destination therapy (VAD(dest), n=15), with VAD waiting for transplant (VAD(htx), n=9), and patients who have been successfully bridged on VAD to transplant (HTX(vad), n=11) were analyzed during the preoperative and the in-hospital postoperative period. International Classification of Diseases (ICD 10) diagnoses, number of contacts with the psychologist, time expenses for individual interventions, family interventions, and concomitant communication were assessed.

Results: Adjustment disorders were the most prevalent disturbances. HTX(vad) patients needed more psychotherapeutic interventions and required more time for individual support than HTX(prim) patients. Partners and families of almost one-half of all patients made use of supportive psychotherapy; there were no differences between the groups with regard to the needed time. Further, the groups did not differ in the time expenses for concomitant communication with the psychologist. At the latest contact with the psychologist, three VAD(dest) patients did not need further psychotherapy at this time; also, one VAD patient waiting for transplant and two after primary HTX were psychosocially stable.

Conclusion: Our data reflect the high emotional distress, especially of HTX(vad) patients. Our data suggest further that patients on VAD support experience psychosocial and emotional stress as severe as HTX candidates and recipients do. Patients on destination therapy and those who are waiting for transplantation do not differ in this regard. The high complexity of the psychosocial problems of VAD and HTX patients warrants professional psychotherapeutic support.