Functional Status in Left Ventricular Assist Device-Supported Patients: A Literature Review

- LVAD patients demonstrate improvement to NYHA functional class I-II throughout first year of therapy, with largest functional gains made during the first 6 months of therapy.
- Physical training intervention studies have demonstrated prevention of weight gain, increased 6-minute walk test distances, and improved pulmonary function, but further intervention studies are needed.
- Pump speed alterations have produced varied results, but further studies should consider the value of submaximal exercise testing which may more clearly reflect the functional gains that patients experience.

The prevalence of advanced heart failure (HF) is increasing because of the aging population and improvements in HF management strategies. Left ventricular assist device (LVAD) technology and management continue to advance rapidly, and it is anticipated that the number of LVAD implants will increase. LVADs have been demonstrated to extend life and improve outcomes in patients with advanced HF. The purpose of this article is to review and synthesize the evidence on impact of LVAD therapy on functional status. Significant functional gains were demonstrated in patients supported by LVAD throughout the 1st year, with most improvement in distance walked and peak oxygen consumption demonstrated in the 1st 6 months. Interventions to enhance exercise performance have had inconsistent effects on functional status. Poor exercise performance was associated with increased risk of adverse events. Functional status improved with LVAD therapy, although performance remained substantially reduced compared with age-adjusted norms. There is tremendous need to enhance our understanding of factors influencing functional outcomes in this high-risk population.