This concept analysis clarified the meaning of unexpected spousal bereavement in older adults using Walker and Avant's method. Three defining attributes were identified: suddenness, unpreparedness, and profound grief. Antecedents included acute illness, accidents, and sudden changes during terminal illness. Consequences involved psychological, physical, and social challenges, as well as difficulties reconstructing daily life. Unexpected spousal bereavement was conceptualized as a disruptive life event affecting older adults' daily functioning and social lives. Clarifying this concept may support assessment and interventions for older adults experiencing sudden spousal loss.
BACKGROUND:Patient selection for destination therapy (DT) with durable left ventricular assist devices (LVADs) remains a major challenge in Asian advanced heart failure practice. In Japan, the J-MACS score is mandatorily calculated before DT implantation and directly influences eligibility decisions; however, its real-world prognostic performance in DT recipients remains unclear. OBJECTIVES:The authors aimed to externally validate the predictability of the J-MACS score on mortality in a nationwide Japanese DT cohort. METHODS:We conducted a nationwide registry-based analysis of patients undergoing HeartMate 3 implantation as DT between May 2021 and October 2025. The primary endpoint was 2-year all-cause mortality. Prognostic performance of the J-MACS score-based on age, prior cardiac surgery, serum creatinine, and central venous pressure-to-pulmonary artery wedge pressure ratio-was evaluated using multivariable Cox models and restricted mean survival time. RESULTS:In total, 210 patients (median age, 60 years; 159 [76%] male) were followed for a median of 514 days (IQR: 257-730 days) after LVAD implantation. The J-MACS score independently predicted mortality (adjusted hazard ratio: 1.17, 95% CI: 1.02-1.36, P = 0.037). The 2-year cumulative mortality rates were 5.8% (95% CI: 2.0%-16.1%) in the low-risk group, 12.7% (95% CI 6.3%-24.6%) in the intermediate-risk group, and 28.6% (95% CI 14.6%-51.2%) in the high-risk group (P = 0.003 for comparison). The high-risk group had approximately 4 months shorter survival. CONCLUSIONS:This nationwide real-world study provides the first validation of a nationally mandated DT eligibility algorithm. The J-MACS score may support risk-based clinical decision-making in Japanese DT practice.
