Sleep and Cognition after Left Ventricular Assist Device Implantation

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PROJECT SUMMARY The purpose of this Ruth L. Kirschstein National Research Service Award (NRSA) Individual Pre-Doctoral Fellowship in Nursing Research (F31) application is to provide research training for Mr. Zheng, a second-year doctoral student at the University of Washington School of Nursing. The long-term goal of this training is for this applicant to develop into an independent influential researcher in a research-intensive academic setting with an innovative and productive interdisciplinary program. This research will be dedicated to integrating physiologic measures into bio-behavioral interventions to reduce and ameliorate symptom burden in individuals with advanced heart failure (AHF) and mechanical circulatory support (MCS) devices. Individuals with AHF experience severe refractory symptom burden despite maximum medical therapy. Cardiac transplant is the optimal treatment option for AHF. However, organ shortage and ineligibility for transplant make MCS devices, such as Left Ventricular Assist Devices (LVADs), the only treatment option for individuals with advanced age and comorbid conditions requiring permanent support, known as destination therapy (DT). The number of patients attaining longer-term survival with DT-LVAD is rapidly growing with increased durability of mechanical support, and expanded indications for DT-LVAD to include patients in earlier stages of heart failure. While studies on sleep and sleep disorders among individuals with heart failure are extensive, investigating sleep as an important clinical outcome for DT-LVAD recipients has not kept pace with the rapidly expanding therapeutic indications and evolving technology advancements in MCS for AHF care. Better understanding of LVAD effects on physical and psychological symptoms will be essential to effectively care for, and support LVAD patients post-implant. The purpose of this prospective concurrent mixed-methods study is to describe changes in objective and subjective sleep quality at 3 months in persons with AHF following DT-LVAD, and to determine associations between change in sleep quality as they relate to changes in cognitive function, psychological symptoms and health-related quality of life. Moreover, this award will prepare a pre-doctoral trainee through advanced coursework and direct research experience, the use of mixed methods, focused analysis of symptom changes observed post-LVAD implant, and discovery of highly relevant links among multiple sleep and AHF-related symptoms. Findings generated from this investigation will provide foundational knowledge for building a new program of research in symptom and symptom management science in AHF.