Impact of Psychosocial Characteristics on Survival in Patients Undergoing Left Ventricular Assist Device (LVAD) Implantation

摘要

Purpose of StudyThe evaluation of patients for LVAD candidacy routinely includes an assessment of patient characteristics referred to as “psychosocial” variables. While psychosocial risk may impact long term survival in heart transplantation, its impact on LVAD outcomes is less clear. We thus sought to determine whether psychosocial characteristics are predictive of worse survival following LVAD implantation. MethodsWe included all patients implanted with an LVAD at our institution from 2008-2018, each of whom underwent a highly detailed psychosocial assessment by our clinical psychology team as part of each patient's comprehensive pre-implant evaluation. Survival analyses were performed using the Fine-Gray model for competing-risks to determine cumulative incidence functions. For statistically significant variables, cause-specific subdistribution hazard ratio estimates were obtained. ResultsA total of 365 patients received an LVAD, 207 as bridge to transplant (BTT) and 158 as destination therapy (DT). The psychosocial characteristics of the entire LVAD cohort, including stratification by LVAD indication of BTT or DT, are shown in the table. Many patients receiving LVADs had features often perceived to be of higher psychosocial risk including absence of a reliable caregiver (26%), gaps in health literacy (30%), and poor medication (18%), diet (37%), and appointment (17%) adherence, respectively. Yet, none of these variables or others were associated with worse survival (Table). The only variable found to be associated with worse survival was living alone (HR 1.76, p=0.02) but this was no longer significant when adjusted for gender and age (p=0.39). Interestingly, a conclusion of “significant or serious” overall psychosocial concerns by a clinical psychologist was also not shown to be associated with worse survival (p=0.47). ConclusionsIn this study, psychosocial variables were not predictive of worse survival in patients undergoing LVAD implantation. However, whether psychosocial risk is associated with an increase in adverse events and/or hospital readmissions in LVAD patients warrants further exploration.