Key elements of left ventricular assist device adjustment: A qualitative exploratory study.

BACKGROUND: Advanced heart failure affects over six million Americans annually. For patients who are ineligible for a heart transplant, left ventricular assist devices (LVADs) offer life-sustaining therapy but require complex adjustment due to external components and lifestyle restrictions. OBJECTIVE: This study aimed to explore how bridge-to-transplant and destination therapy recipients perceive and adjust to LVAD-supported life. METHODS: Using general qualitative methods, 20 LVAD recipients (mean age 57; 65% male) from two high-volume urban centers participated in semi-structured interviews guided by the Roy Adaptation Model. Data were analyzed iteratively using ATLAS.ti, achieving thematic saturation. RESULTS: Participants described key elements of LVAD adjustment: physical ability, caregiver dependence, self-care, roles, public perception, and emotional connection. Most reported improved physical function but faced challenges with hygiene, clothing, sleep, travel, and employment. Public misperceptions and visibility of the device affected self-image, particularly among women. Peer and provider relationships were central to emotional adaptation. Despite the inconveniences, participants expressed gratitude for the LVAD as a life-sustaining device. CONCLUSION: The findings highlight the importance of connection, role restoration, and public perception-factors that are often underrepresented in clinical care. Participants emphasized the need for expanded education on recovery, hygiene, equipment, travel, and complication management, as well as tailored support for patients without caregivers. Addressing these psychosocial and practical challenges may improve patient satisfaction, safety, and long-term outcomes.