Date Presented 04/22/2023

Purpose: Describe feasibility and clinical value of preoperative OT evaluations for left ventricular assist device (LVAD) candidates. Design & Method: Single-center observational; descriptive analyses of 139 candidates’ OT evaluations. Results: Cognition, frailty, activities of daily living, and LVAD care measures led OT to predict that 36% would need no assist, 39% some assist, and 24% 24/7 supervision to manage LVADs. Conclusion: The OT protocol gave insight into candidates’ LVAD self-care needs and was feasible. Impact: Supports OT preoperative LVAD consults as standard of care.

Primary Author and Speaker: Jessica Asiello

Additional Authors and Speakers: Christina M. Kelley

Contributing Authors: John Wong, Marissa Dittrich, Abigail Begin, Kimberly Beatty, Erin Donovan, Kellie Cannone, Miranda Mlincek, Zeina Fayad

PURPOSE: Over 25k US adults with heart failure have left ventricular assist devices (LVAD) (Molina et al., 2021). LVADs involve complex self-care demands (Spielmann et al., 2021) and are challenging for clients with frailty and cognitive deficits. Yet, programs do not consistently do pre-op functional screens and there is scarce evidence on these needs (Clancy et al., 2019). To address this gap, an OT department developed a protocol for LVAD candidates. Aims: Describe feasibility of pre-op OT evals as standard care. Characterize functional needs of this complex, growing population.

DESIGN: IRB-approved descriptive study of an OT protocol for LVAD candidates at an urban hospital (2019-22).

METHOD: Medical records data from pre-op OT evals were entered into a secure database. Coders had high inter-rater reliability (>0.9). Measures: Montreal Cognitive Assessment and Allen Cognitive Level Screen for cognition. Dynamometer for grip strength, a marker of frailty (Chung et al., 2014). Activity Measure for Post-Acute Care for ADL. Performance-based ordinal scale for LVAD self-care. Nominal coding of OT notes for LVAD self-care prognoses.

RESULTS: Of n=161 OT consults, 86% were evaluated (n=139), 73% inpatient and 27% outpatient, with mean length of 63 min in 1.2 sessions. Cognitive scores were below norms (MoCA M=23.3, SD=4.1; ACLS M=4.8, SD=0.5). Mean GS was 61.8 lb (SD=26.3) for R hand and 62.1 (SD=25.9) for L. AM-PAC was M=21.6 (SD = 4.0). 87% required cueing or physical assist on LVAD self-care. OT predicted 36% would need no assist, 39% some assist and 24% 24/7 supervision to manage LVADs post-op.

CONCLUSION: OT pre-op evals provide rich insight to the medical team on candidates’ functional needs and prognosticated LVAD self-management. This protocol was feasible in clinical care.

IMPACT: LVAD candidates are an emerging area of OT practice with anticipated increased volume and complexity. These data advocate for LVAD programs to routinely consult OT pre-op to optimize care.


Chung, C. J., Wu, C., Jones, M., Kato, T. S., Dam, T. T., Givens, R. C., ... Schulze, P. C. (2014). Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement. Journal of Cardiac Failure, 20(5), 310-315.

Clancy, M. J., Jessop, A. B., & Eisen, H. (2019). Assessment of pre-operative psychosocial function among people receiving left ventricular assist devices: A national survey of US LVAD programs. Heart & Lung, 48(4), 302-307.

Molina, E. J., Shah, P., Kiernan, M. S., Cornwell III, W. K., Copeland, H., Takeda, K., Fernandez, F. G., Badhwar, V., Habib, R. H., Jacobs, J. P., Koehl, D., Kirklin, J. K., Pagani, F. D., & Cowger, J. A. (2021). The Society of Thoracic Surgeons INTERMACS 2020 annual report. Annals of Thoracic Surgery, 111(3), 778–792.

Spielmann, H., Seemann, M., Friedrich, N., Tigges-Limmer, K., Albert, W., Semmig-Könze, S., Spitz-Köberich, C., & Kugler, C. (2021). Self-management with the therapeutic regimen in patients with ventricular assist device (VAD) support – A scoping review. Heart & Lung, 50(3), 388–396.