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Psychosocial Characteristics and Outcomes in Patients with Ventricular Assist Device
S448
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
Results: Of the 82 patients, 46 (56%) had a score < 21, while 36 (44%) had a score ≥ 21. There were no differences in baseline characteristics including age (58 vs 56, p=0.5), gender (Male: 85% vs 72%, p=0.2), INTERMACS class (3 vs 3, p=0.9), EF (18% vs 17%, p=0.4), GFR (71 vs 66, p=0.4), median days on LVAD support (138 vs 164, p=0.9), or device type. There was no difference in the composite outcome of death or readmission for HF, bleeding, infection, or stroke [Figure 1], or any of the individual components between those with SIPAT scores < 21 versus ≥ 21. Conclusion: Unlike cardiac transplant, the SIPAT score was not predictive of medical outcomes in patients undergoing LVAD therapy. A patient’s underlying biologic effects may influence outcomes more than their psychosocial aspects. Prospective studies should be considered to further explore the validity of the SIPAT score in patients undergoing LVAD implantation.
within the first year was 2.5 § 2.6, and mean number of days to first readmission was 80 § 91. Those with less than a high school education were 55% more likely to experience an adverse event (driveline infection, bacteremia, stroke, hemolysis, GI bleed, other bleed) compared to those with a graduate level education (p < 0.05), but showed no difference in mortality or readmission rates. There was no statistically significant difference in 30day mortality, 1-year mortality, all-cause mortality, days to first readmission, number of readmissions within 1-year, and adverse events based on remaining aforementioned psychosocial risk factors. Conclusion: These results suggest that certain psychosocial factors may not influence mortality or adverse event rates after VAD implantation. Although, education level impacted adverse event rates, further delineation is required. A larger sample size is needed to elucidate exactly which psychosocial characteristics affect VAD outcomes.
1132 Lower Pre-Implantation Psychosocial Risk Scores Do Not Correlate with Better Survival Following Left Ventricular Assist Device (LVAD) Placement N. Grigoryan, L. Brobst, H. Zhao and E. Hamad. Temple University School of Medicine, Philadelphia, PA.
Figure 1
Freedom From Composite Endpoint by SIPAT Score.
1131 Psychosocial Characteristics and Outcomes in Patients with Ventricular Assist Device C. Morreale,1 R. Paliga,2 S. Kothari,1 K. Meehan,2 L. Coyle,2 M. Morack,2 S. Pauwaa,2 G. Macaluso,2 A. Joshi,2 C. Sciamanna,2 A. Tatooles,3 P. Pappas,3 W. Cotts,2 and A. Andrade.2 1Medicine, UIC/ Advocate Christ Medical Center, Oak Lawn, IL; 2Cardiology, Advocate Christ Medical Center, Oak Lawn, IL; and the 3Cardiovascular and Thoracic Surgery, Advocate Christ Medical Center, Oak Lawn, IL. Purpose: Patient selection for durable ventricular assist device (VAD) involves a comprehensive medical and psychosocial evaluation. Although there are guidelines for evaluation of medical comorbidities, psychosocial risk assessment remains somewhat subjective. There is ongoing concern that patients may be denied VAD due to perceived high-risk psychosocial characteristics that may not impact survival after VAD implantation. The purpose of this study was to evaluate the patient psychosocial risk profile and its impact on outcomes after VAD implantation. Methods: This study was a single center, retrospective analysis of 93 patients who underwent durable VAD implantation at Advocate Christ Medical Center in 2016. Psychosocial factors on outcomes were evaluated using the Student’s t-test, Fischer’s exact test, and one-way analysis of variance. Results: Of 93 patients, mean age was 55 § 13 years, 73% were males, 46% were African American, 69% had non-ischemic cardiomyopathy, and 60% received destination therapy. Most prevalent psychosocial factors were: 27% had a pre-existing psychiatric diagnosis, 53% were not married, 22% had no children, 11% lived alone, 19% did not complete a high school education, 26% were chronically unemployed, 55% formerly abused tobacco, 13% formerly abused alcohol, and 24% formerly abused illicit drug. Mean days on device was 589 § 321, mean number of readmissions
Purpose: The assessment of psychosocial risk is an important component in the selection of appropriate candidates for LVAD implementation, however the influence on disease outcome remains poorly studied. In this study, we evaluated the effects of psychosocial risk on mortality, complications, and recurrent admissions. Methods: We performed a retrospective chart review of patients with refractory systolic heart failure who underwent LVAD placement between 2009 and 2018 (N=94). The psychosocial risk, ranging low to high (0-4), was determined through assessment of finances, support system, understanding, compliance, substance abuse, mental health, adjustment, and cognition. The primary outcome was overall survival. Secondary outcomes were development of driveline infections, GI bleeds, other bleeds, stroke, thrombus, and readmissions. Results: The mean age of patients was 57 years, 74% being male. At the end of 2 years, there were 30 deaths (31.9%). At 6, 12, and 24 months, the patients with the lowest psychosocial risk (score 0) had the highest mortality (P=0.043). The number of psychosocial risk factors that each patient had did not affect survival (P=0.21). For secondary outcomes, psychosocial risk did not correlate with development of strokes, thrombi, other bleeds, or readmissions. Patients with higher risk scores developed less GI bleeds than those with lower scores (P=0.018). Conclusion: We found that lower psychosocial risk scores did not correlate with better survival in patients who received an LVAD. However, patients with a low psychosocial risk had significantly worse mortality than other groups. Additionally, there was no correlation between risk score and complications, except GI bleeds, which were significantly higher in patients with lower scores. Given the smaller number of patients who had higher psychosocial risk scores (scores 3 and 4), further studies are required to better understand this association.
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
Results: Of the 82 patients, 46 (56%) had a score < 21, while 36 (44%) had a score ≥ 21. There were no differences in baseline characteristics including age (58 vs 56, p=0.5), gender (Male: 85% vs 72%, p=0.2), INTERMACS class (3 vs 3, p=0.9), EF (18% vs 17%, p=0.4), GFR (71 vs 66, p=0.4), median days on LVAD support (138 vs 164, p=0.9), or device type. There was no difference in the composite outcome of death or readmission for HF, bleeding, infection, or stroke [Figure 1], or any of the individual components between those with SIPAT scores < 21 versus ≥ 21. Conclusion: Unlike cardiac transplant, the SIPAT score was not predictive of medical outcomes in patients undergoing LVAD therapy. A patient’s underlying biologic effects may influence outcomes more than their psychosocial aspects. Prospective studies should be considered to further explore the validity of the SIPAT score in patients undergoing LVAD implantation.
within the first year was 2.5 § 2.6, and mean number of days to first readmission was 80 § 91. Those with less than a high school education were 55% more likely to experience an adverse event (driveline infection, bacteremia, stroke, hemolysis, GI bleed, other bleed) compared to those with a graduate level education (p < 0.05), but showed no difference in mortality or readmission rates. There was no statistically significant difference in 30day mortality, 1-year mortality, all-cause mortality, days to first readmission, number of readmissions within 1-year, and adverse events based on remaining aforementioned psychosocial risk factors. Conclusion: These results suggest that certain psychosocial factors may not influence mortality or adverse event rates after VAD implantation. Although, education level impacted adverse event rates, further delineation is required. A larger sample size is needed to elucidate exactly which psychosocial characteristics affect VAD outcomes.
1132 Lower Pre-Implantation Psychosocial Risk Scores Do Not Correlate with Better Survival Following Left Ventricular Assist Device (LVAD) Placement N. Grigoryan, L. Brobst, H. Zhao and E. Hamad. Temple University School of Medicine, Philadelphia, PA.
Figure 1
Freedom From Composite Endpoint by SIPAT Score.
1131 Psychosocial Characteristics and Outcomes in Patients with Ventricular Assist Device C. Morreale,1 R. Paliga,2 S. Kothari,1 K. Meehan,2 L. Coyle,2 M. Morack,2 S. Pauwaa,2 G. Macaluso,2 A. Joshi,2 C. Sciamanna,2 A. Tatooles,3 P. Pappas,3 W. Cotts,2 and A. Andrade.2 1Medicine, UIC/ Advocate Christ Medical Center, Oak Lawn, IL; 2Cardiology, Advocate Christ Medical Center, Oak Lawn, IL; and the 3Cardiovascular and Thoracic Surgery, Advocate Christ Medical Center, Oak Lawn, IL. Purpose: Patient selection for durable ventricular assist device (VAD) involves a comprehensive medical and psychosocial evaluation. Although there are guidelines for evaluation of medical comorbidities, psychosocial risk assessment remains somewhat subjective. There is ongoing concern that patients may be denied VAD due to perceived high-risk psychosocial characteristics that may not impact survival after VAD implantation. The purpose of this study was to evaluate the patient psychosocial risk profile and its impact on outcomes after VAD implantation. Methods: This study was a single center, retrospective analysis of 93 patients who underwent durable VAD implantation at Advocate Christ Medical Center in 2016. Psychosocial factors on outcomes were evaluated using the Student’s t-test, Fischer’s exact test, and one-way analysis of variance. Results: Of 93 patients, mean age was 55 § 13 years, 73% were males, 46% were African American, 69% had non-ischemic cardiomyopathy, and 60% received destination therapy. Most prevalent psychosocial factors were: 27% had a pre-existing psychiatric diagnosis, 53% were not married, 22% had no children, 11% lived alone, 19% did not complete a high school education, 26% were chronically unemployed, 55% formerly abused tobacco, 13% formerly abused alcohol, and 24% formerly abused illicit drug. Mean days on device was 589 § 321, mean number of readmissions
Purpose: The assessment of psychosocial risk is an important component in the selection of appropriate candidates for LVAD implementation, however the influence on disease outcome remains poorly studied. In this study, we evaluated the effects of psychosocial risk on mortality, complications, and recurrent admissions. Methods: We performed a retrospective chart review of patients with refractory systolic heart failure who underwent LVAD placement between 2009 and 2018 (N=94). The psychosocial risk, ranging low to high (0-4), was determined through assessment of finances, support system, understanding, compliance, substance abuse, mental health, adjustment, and cognition. The primary outcome was overall survival. Secondary outcomes were development of driveline infections, GI bleeds, other bleeds, stroke, thrombus, and readmissions. Results: The mean age of patients was 57 years, 74% being male. At the end of 2 years, there were 30 deaths (31.9%). At 6, 12, and 24 months, the patients with the lowest psychosocial risk (score 0) had the highest mortality (P=0.043). The number of psychosocial risk factors that each patient had did not affect survival (P=0.21). For secondary outcomes, psychosocial risk did not correlate with development of strokes, thrombi, other bleeds, or readmissions. Patients with higher risk scores developed less GI bleeds than those with lower scores (P=0.018). Conclusion: We found that lower psychosocial risk scores did not correlate with better survival in patients who received an LVAD. However, patients with a low psychosocial risk had significantly worse mortality than other groups. Additionally, there was no correlation between risk score and complications, except GI bleeds, which were significantly higher in patients with lower scores. Given the smaller number of patients who had higher psychosocial risk scores (scores 3 and 4), further studies are required to better understand this association.