Patients living with left ventricular assist devices (LVADs) often face significant mental health challenges, including and anxiety. But because of the complexity of their medical needs, access to inpatient psychiatric care has historically been limited. A new case report from clinicians at Tufts Medical Center outlines how a multidisciplinary approach is allowing clinicians to safely provide inpatient psychiatric treatment for Tufts Medical Center patients with LVADs.
Published in the ASAIO Journal, the paper highlights how collaboration between cardiology, psychiatry, nursing and hospital leadership supports the successful psychiatric hospitalization of a patient living with an LVAD while maintaining safe device management and medical oversight.
Addressing a growing gap in care
Psychiatric conditions are increasingly common among patients with LVADs and are associated with higher risks of rehospitalization, medication nonadherence and reduced quality of life. Yet most psychiatric facilities are not equipped to care for these patients because LVADs require specialized monitoring, staff training and emergency protocols.
The team recognized the need for a structured approach that would allow patients to receive both the psychiatric care and advanced cardiac support they need in a safe environment.
"Patients with LVADs can face significant mental health challenges, but many psychiatric units aren’t equipped to safely care for them," said lead author Deborah Fleck, RN, BSN, clinical leader in Tufts Medical Center’s Cardiac Transplant Program. "Our goal was to create a structured, collaborative approach that would allow these patients to receive the psychiatric support they need while maintaining the highest standards of cardiac care and safety."
An unmatched approach to collaboration
The report details the development of an institutional policy framework that enabled inpatient psychiatric admission for medically stable LVAD patients.
Clinicians from advanced heart failure, psychiatry, nursing and hospital leadership worked together to establish protocols for patient eligibility, daily monitoring, staff education and emergency preparedness. The framework also included targeted LVAD training for psychiatric unit staff and clear communication pathways between clinical teams.
By creating standardized processes and role-specific competencies, the team was able to safely care for a patient experiencing severe depression and suicidal ideation within a locked inpatient psychiatric unit.
Putting the patient first—always
During the hospitalization, the patient received daily psychiatric care, including psychotherapy, behavioral occupational therapy and medication management, while continuing to receive oversight from the heart failure team. No LVAD-related complications occurred during the admission. The case demonstrates how integrated care models can help address an important unmet need for patients living with advanced heart failure and mental health conditions.
"This is about treating the patient, not the device," said Shannon Niles, MSN, RN, Professional Development Director of Inpatient Psychiatry, Tufts Medical Center. "It really comes down to collaboration and trust between teams. When cardiology, psychiatry, nursing and leadership are aligned, we’re able to deliver care that truly covers the whole patient. That kind of teamwork is what makes this possible."
A model for other hospitals
The team hopes this framework can serve as a model for other healthcare systems seeking to expand access to psychiatric care for patients with LVADs and other advanced medical devices.
As more patients live longer with durable mechanical circulatory support, the need for coordinated mental health care is expected to grow. The authors emphasize that proactive mental health support is essential not only for emotional well-being, but also for improving long-term health outcomes and quality of life.
Advancing patient-centered care through collaboration
Clinician researchers at Tufts Medical Center continue to explore new ways to deliver more coordinated, compassionate and accessible care for patients with complex medical and behavioral health needs. This work highlights the importance of interdisciplinary collaboration in expanding care options for vulnerable patient populations while maintaining the highest standards of safety and quality.
"Providing safe, effective psychiatric care for patients with LVADs means keeping the focus on the whole person," said Molly Forsa, MSN, RN, Clinical Nursing Director, Inpatient Psychiatry, Tufts Medical Center. "When we bring together expertise from across disciplines, we’re able to support cardiac needs and mental health. That coordination is really what makes this a new standard of care.”
About Tufts Medicine Heart Failure + Transplant Care
Tufts Medicine is a regional leader in advanced cardiac care, offering expertise in heart transplantation, LVAD therapy and complex heart failure management. With the #1 heart transplant program in New England, we are advancing research and developing innovative care models that improve outcomes for patients with advanced heart disease.
