Psychological and socioeconomic impact of long-term home management on patients with left ventricular assist devices and their caregivers: a nationwide multicenter questionnaire survey.
Watanabe M, Matsumiya G, Kohno H, Kinugawa K • Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs • 2026
Under Japan's former 24-h caregiver-accompaniment framework, LVAD households reported substantial psychological and socioeconomic burdens, with depressive symptoms in over one-third of both patients and caregivers and significantly higher rates among those with caregiver-accompaniment burden.
Key Findings
Results
Psychological burden related to caregiver accompaniment was reported by the majority of both LVAD patients and their primary caregivers.
83.7% of patients reported psychological burden related to caregiver accompaniment.
61.8% of caregivers reported psychological burden related to caregiver accompaniment.
Data were collected from 184 patients and 136 primary caregivers across 79 LVAD centers in Japan.
The survey was conducted between April and July 2024 as a cross-sectional, nationwide anonymous web-based questionnaire.
Results
Depressive symptoms were reported in approximately one-third of both LVAD patients and primary caregivers.
36.4% of LVAD patients reported depressive symptoms.
35.3% of primary caregivers reported depressive symptoms.
These findings were obtained under Japan's former 24-h caregiver-accompaniment framework.
Multivariable logistic regression was used to identify factors associated with depressive symptoms.
Results
Depressive symptoms were significantly more frequent among respondents who experienced caregiver-accompaniment burden compared to those without such burden, in both patients and caregivers.
Among patients, depressive symptoms occurred in 39.6% (61/154) of those with caregiver-accompaniment burden vs. 20.0% (6/30) of those without (p = 0.041).
Among caregivers, depressive symptoms occurred in 45.2% (38/84) of those with caregiver-accompaniment burden vs. 19.2% (10/52) of those without (p = 0.002).
The association was statistically significant in both respondent groups.
Prespecified comparisons were performed separately within each respondent group (patients and caregivers).
Results
A substantial proportion of LVAD patients and caregivers reported not working or studying, indicating socioeconomic disruption under the 24-h accompaniment framework.
44.0% of patients reported not working or studying.
31.6% of caregivers reported not working or studying.
Depressive symptoms did not differ significantly according to work/study status in either group.
This socioeconomic impact was observed under Japan's former framework that historically required or strongly expected continuous caregiver availability.
Results
Depressive symptom rates did not differ significantly based on work or study status in either patients or caregivers.
Unlike caregiver-accompaniment burden, work/study status was not significantly associated with depressive symptoms.
This finding applied to both the patient and caregiver respondent groups.
Prespecified comparisons of depressive symptoms according to work/study status were performed within each respondent group.
Both caregiver-accompaniment burden and work/study status were prespecified comparison variables.
Conclusions
The study provides real-world baseline data intended to evaluate the impact of Japan's recent policy relaxation of the 24-h caregiver-accompaniment requirement for LVAD home management.
Japan's continuous caregiver availability requirement for LVAD home management has recently been relaxed.
The survey was conducted across 79 LVAD centers nationwide.
The authors describe these findings as "real-world baseline data for evaluating recent policy relaxation and for designing support systems that promote quality of life and social reintegration while maintaining safety."
The study used a cross-sectional design with de-identified individual-level data.
What This Means
This research surveyed patients in Japan who use left ventricular assist devices (LVADs) — mechanical pumps that help a failing heart — and the family members or friends who care for them at home. Until recently, Japanese policy required that a caregiver be present with the LVAD patient around the clock. The study found that this requirement placed a heavy burden on both groups: more than 8 in 10 patients and about 6 in 10 caregivers reported feeling psychologically burdened by having to always have someone present. Around one-third of both patients and caregivers showed signs of depression, and roughly 44% of patients and 32% of caregivers said they had stopped working or studying due to the demands of home management.
One of the key findings was that people who felt burdened by the constant accompaniment requirement were significantly more likely to experience depressive symptoms — this was true for both patients and caregivers. In contrast, whether or not someone was working or studying was not significantly linked to depression rates, suggesting the psychological toll of the accompaniment requirement itself, rather than employment disruption alone, may be a key driver of mental health difficulties.
This research matters because Japan has recently begun relaxing its strict caregiver-accompaniment rules for LVAD patients, and this survey provides a baseline picture of what conditions looked like under the old system. This research suggests that the previous framework imposed considerable mental health and social costs on LVAD households, and the findings can help guide the design of better support systems — ones that allow patients and caregivers to maintain a better quality of life and remain socially engaged while still keeping patients safe.
Watanabe M, Matsumiya G, Kohno H, Kinugawa K. (2026). Psychological and socioeconomic impact of long-term home management on patients with left ventricular assist devices and their caregivers: a nationwide multicenter questionnaire survey.. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs. https://doi.org/10.1007/s10047-026-01569-4