PROJECT SUMMARY Patient activation, cognition, and self-management for LVADs We propose to study patient activation (PA) for patients with left-ventricular assist devices (LVADs). LVADs are the most complex machines ever designed for home use with rigorous demands for self- management (SM) of alarms, batteries, anticoagulation, and complications, in addition to the routine burden of heart failure (HF) care. Since 2012, 27,000+ LVAD implantations have extended the life of the sickest HF patients. Most LVADs are implanted permanently. LVAD SM must combat infection, stroke, GI bleed, and device malfunction further challenged by medical comorbidities and tenuous caregiver availability. Healthcare utilization (HCU) for post-LVAD complications is high and costly. PA is the willingness and ability to manage a health condition and influences HF SM and HCU. PA can be improved with treatment. PA for LVAD patients has received little attention and is not usually assessed before or after surgery. Cognitive impairment is common in HF, reduces HF SM prior to LVAD, and impacts pre-LVAD candidacy decisions. Cognition affects LVAD SM and predicts LVAD stroke, death and hospitalization, but the relationship between cognition, PA, and LVAD SM is unknown. We believe PA influences the impact of cognition on outcomes and offers unique insights and treatment opportunities for LVAD SM. We plan analyses of the relationships between cognition, PA, LVAD SM, and HCU and preliminary examination of whether PA acts as a mediator for the relationship of cognition with LVAD SM and HCU. Specifically, we will first examine the associations among PA, cognition, LVAD SM (care-adherence reported by patients and caregivers) and LVAD HCU (total days out of hospital, LVAD complications, telephone calls) through assessments 3-,6-,9-,12-months after LVAD surgery. We will next explore whether PA behaves as a mediator of cognition for LVAD SM and HCU. This innovative, interdisciplinary study will build the science for optimizing SM and HCU for patients with complex, chronic care needs. As a modifiable construct, PA is a novel intervention target. Findings will identify relationships between cognition, PA, and LVAD SM and optimal assessment points to guide future intervention trials. Results may be relevant to PA and SM for the escalating number of HF patients without LVAD, as well as patients with other chronic illnesses.