The restore-adapt-abandon framework: supporting safe and meaningful living after ventricular assist device implantation

Background Ventricular assist device (VAD) therapy improves survival and symptoms in patients with advanced heart failure but can impose lifestyle restrictions that challenge meaningful living. Engagement in meaningful activities is protective against all-cause mortality and positively impacts health, well-being, and quality of life, yet little is known about how VAD recipients adapt these activities post-implantation. Objectives To explore how VAD recipients navigate meaningful activity engagement post-implantation, and present a clinically-relevant framework characterizing how VAD recipients engage in meaningful activities across the post-implant trajectory. Methods We analyzed semi‑structured interview data from VAD recipients in the Southeastern U.S. and used thematic analysis to explore patterns of activity engagement and adaptation. Results Two major themes emerged: (1) symptom relief enables restoration of activities and social roles; and (2) identity shifts and risk management prompt modified engagement. Across themes, patients described strategies and constraints including planning over spontaneity, managing device visibility and stigma, out-of-pocket costs, caregiver-linked mobility, and climate sensitivity. These patterns informed a "restore-adapt-abandon" framework for meaningful activity engagement across the post-VAD trajectory. Conclusion Based on the findings, we recommend structured values elicitation, patient-clinician co-planning of activity adaptations, and identity-focused psychosocial support into routine VAD care. These strategies can optimize meaningful living alongside safety and redefine success in VAD therapy from survival alone to living well.