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"Where's the Rest of Me???"


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Pamela Combs, PhD, RN
Seton Medical Center
Austin, TX, USA
Pscombs@seton.org



"It is not enough to be industrious; so are the ants. What are you industrious about?"
-Henry David Thoreau [1]

As this author and Dr. Vincent Valentine confess and share a mutual passion regarding the movie classics, a relevant and most famous quote, "Where's the rest of me?" contained in President Ronald Reagan's best known film was discovered [2]. The intellectual discussion around the quality of life (QOL) of Ventricular Assist Device (VAD) patients, and their quest for finding answers to "where's the rest of me?" has prompted providers to reassure VAD patients with a common mantra, "we are focused on providing you a life with quality." Certainly, this should serve as a reminder of "What's it all about?" in all endeavors for all patients in need of health care, and especially patients with failing hearts, failing lungs and recipients of replacement therapies including heart and lung transplantation. However, the focus of this brief primer is on the ever-important topic of QOL among VAD patients.

QOL is a subjective evaluation whereby an individual shares his/her overall appraisal of how happy, satisfied, and content he/she is with their life. QOL differs with every individual on the basis of each patient's life experience, expectations, attitudes, values, and beliefs [3]. Within the VAD field we typically define QOL as an individual's perception of the impact of the VAD on his/her life. Fortunately, numerous studies have been dedicated to evaluate this most crucial aspects of the patient's life [4-8]. QOL can be measured with health status questionnaires that are prompted by Intermacs and/or by customized surveys designed by individual VAD programs; thus, an assurance is rendered that QOL evaluation remains threaded through-out the provider's focus.

It is encouraging to note that QOL matters remain a significant and contemporary focus within the VAD field. The upcoming ISHLT conference agenda has allotted time to the QOL topics:

  1. The Presidential DebateTopic - Destination Therapy/Heart Transplant among patients over the age of 70
  2. QOL after the VAD: The impact of frailty and social behaviors on QOL
  3. Engaging patients and caregivers: Successful strategies to care of patients living far away, to name a few

To those VAD patients past, present, and future, yearning to discover "Where is the rest of me," rest assured that the providers entrusted with your care are dedicated to helping you find your answers. As Thoreau's quote infers, those of us in the VAD profession remain focused on what it is that we are truly industrious about, the VAD patient's QOL. That's what it's all about. ■


References:

Disclosure Statement: The author has no conflicts of interest to disclose.

  1. Thoreau, H. D. (1857). Letter to his friend, H.G.O. Blake, on 16 November.
  2. Reagan, R. & Gibson R.H. (1981). Where's the Rest of Me?: The autobiography of Ronald Reagan. Karz Publishers: New York.
  3. MacIver, J. (2012) Quality of life and left ventricular device support. Circulation, 126, pp. 866-874.
  4. Dew, M.A., Kormos, R.L., & Winowich, S.;(1999). Quality of life outcomes in left ventricular assist system inpatients and outpatients. ASAIO, 45, pp. 218-225.
  5. Grady, K., Meyer, P.M., & Dressler. D. (2004). Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation. AnnalsThoracic Surgery, 77, pp. 1321-1327.
  6. Grady, K.L., Meyer, P., Mattea, A. (2001) Improvement in quality of life outcomes two weeks after left ventricular assist device implantation. Journal of Heart Lung Transplant. 20, pp. 657-669.
  7. Rogers, et al. (2010). Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. Journal of American Cardiology, 55(17), pp. 1826-1834.
  8. Rogers, J.G., Butler, J., Lansman, S.L. (2007). Chronic mechanical circulatory support for inotrope-dependent heart failure patients who are not transplant candidates: Results of the INTrEPID Trial. Journal American College Cardiology, 50, pp. 741-747.



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