Comparison of self-care behaviors between Israeli and Japanese patients with left ventricular assist devices

Self-care is essential for patients supported with left ventricular assist devices (LVAD) to prevent complications and improve outcomes. However, self-care behaviors, defined as the activities that patients undertake to maintain health may vary across healthcare systems and cultural contexts.

To compare self-care behaviors between Israeli and Japanese patients living with LVAD.

This cross-sectional study included 117 patients with LVAD (Israel n = 52; Japan n = 65). Demographic, clinical, and device-related characteristics were collected. Self-care was assessed using a 20-item LVAD self-care behavior scale on a 5-point Likert scale from 1 (Never) to 5 (Always). The scale includes ‘monitoring’, ’heart failure (HF) self-care’, and ’LVAD-specific self-care’ subscales. Total and subscale scores ranged from 0 to 100, with higher scores indicating better self-care. Group differences were examined using independent-samples t-tests or Fisher’s exact tests, as appropriate.

Patients from Israel were significantly older than Japanese patients (61.7 ± 9 vs. 41.3 ± 11 years, p < .001). Significant between-country differences were observed in marital status, education level, and LVAD indication. Higher education levels were observed among Japanese patients (59% vs 35%, p < .01). A higher proportion of Israeli patients were married than Japanese patients (77% vs 55%, p = .02) and destination therapy was observed only in participant from Israel (9 [18%]).

Japanese patients had higher scores on the monitoring subscale (92.5±9 vs 85.9±17, p = .014), whereas LVAD self-care scores were higher among Israeli patients (94.3±8 vs 90.3±11, p = .020). No differences between Israeli and Japanese patients were observed in total self-care (86.8±10 vs 87.5±9, p = .68) or HF self-care (77.9±17 vs 75.5±15, p = .41) subscale scores. At the item level (scores ranging from 1 to 5, with higher scores indicating better self-care), Japanese patients reported higher adherence for monitoring behaviours such as weighing themselves (4.9 ± 0.4 vs 4.2 ± 1.0, p < .001) and monitoring the driveline exit site (4.9 ± 0.3 vs 4.5 ± 1.0, p < .01). Israeli patients reported higher adherence for several LVAD self-care behaviours, including equipment checks (4.9 ± 0.3 vs 4.6 ± 0.7, p < .001), exit-site care (4.9 ± 0.4 vs 4.6 ± 0.7, p = .031), INR monitoring (5.0 ± 0.2 vs 4.6 ± 0.8, p = .001), coping support (4.9 ± 0.4 vs 4.5 ± 0.8, p < .01), and adherence to HF self-care behaviours such as a heart-healthy diet (4.1 ± 1.0 vs 3.7 ± 0.9, p = .04).

Self-care behaviors among patients with LVAD differ between Israeli and Japanese populations, particularly in monitoring and LVAD-specific self-care domains. These findings highlight the importance of culturally and contextually tailored self-care education to optimize outcomes in patients supported with LVAD.