# Patient activation, cognition, and self-management for LVADs

> **NIH NIH R21** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2024 · $485,826

## Abstract

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.

## Key facts

- **NIH application ID:** 10810079
- **Project number:** 1R21NR020646-01A1
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jesus Casida
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $485,826
- **Award type:** 1
- **Project period:** 2024-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10810079

## Citation

> US National Institutes of Health, RePORTER application 10810079, Patient activation, cognition, and self-management for LVADs (1R21NR020646-01A1). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10810079. Licensed CC0.

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