Arturo Rodríguez|Ramsey M. Wehbe|Allen S. Anderson|Kambiz Ghafourian|Ike S. Okwuosa|Jane E. Wilcox|Esther Vorovich|Arnaud Hubert|Duc Thinh Pham|Jonathan D. Rich
Impact of Psychosocial Characteristics on Survival in Patients Undergoing Left Ventricular Assist Device (LVAD) Implantation
Northwestern University|Northwestern University|Northwestern University|Northwestern University|Northwestern University|Northwestern University|Northwestern University|Northwestern University|Northwestern University|Northwestern University
purpose studythe evaluation patients lvad candidacy routinely includes assessment patient characteristics referred psychosocial variables psychosocial risk may impact long term survival heart transplantation impact lvad outcomes less clear thus sought determine whether psychosocial characteristics predictive worse survival following lvad implantationmethodswe included patients implanted lvad institution 20082018 underwent highly detailed psychosocial assessment clinical psychology team part patients comprehensive preimplant evaluation survival analyses performed using finegray model competingrisks determine cumulative incidence functions statistically significant variables causespecific subdistribution hazard ratio estimates obtainedresultsa total 365 patients received lvad 207 bridge transplant btt 158 destination therapy dt psychosocial characteristics entire lvad cohort including stratification lvad indication btt dt shown table many patients receiving lvads features often perceived higher psychosocial risk including absence reliable caregiver 26 gaps health literacy 30 poor medication 18 diet 37 appointment 17 adherence respectively yet none variables others associated worse survival table variable found associated worse survival living alone hr 176 p002 longer significant adjusted gender age p039 interestingly conclusion significant serious overall psychosocial concerns clinical psychologist also shown associated worse survival p047conclusionsin study psychosocial variables predictive worse survival patients undergoing lvad implantation however whether psychosocial risk associated increase adverse events andor hospital readmissions lvad patients warrants exploration evaluation patients lvad candidacy routinely includes assessment patient characteristics referred psychosocial variables psychosocial risk may impact long term survival heart transplantation impact lvad outcomes less clear thus sought determine whether psychosocial characteristics predictive worse survival following lvad implantation included patients implanted lvad institution 20082018 underwent highly detailed psychosocial assessment clinical psychology team part patients comprehensive preimplant evaluation survival analyses performed using finegray model competingrisks determine cumulative incidence functions statistically significant variables causespecific subdistribution hazard ratio estimates obtained total 365 patients received lvad 207 bridge transplant btt 158 destination therapy dt psychosocial characteristics entire lvad cohort including stratification lvad indication btt dt shown table many patients receiving lvads features often perceived higher psychosocial risk including absence reliable caregiver 26 gaps health literacy 30 poor medication 18 diet 37 appointment 17 adherence respectively yet none variables others associated worse survival table variable found associated worse survival living alone hr 176 p002 longer significant adjusted gender age p039 interestingly conclusion significant serious overall psychosocial concerns clinical psychologist also shown associated worse survival p047 study psychosocial variables predictive worse survival patients undergoing lvad implantation however whether psychosocial risk associated increase adverse events andor hospital readmissions lvad patients warrants exploration