Value of psychosocial evaluation for left ventricular assist device candidates

• Type of Material: Article
• Authors: Caroline K. Olt, Emory University; Lucy W. Thuita, Department of Quantitative Health Sciences Cleveland; Edward G. Soltesz, Case Western Reserve University; Michael Z. Tong, Case Western Reserve University; Aaron J. Weiss, Cleveland Clinic Foundation; Kay Kendall, Transplant Center Cleveland; Jerry D. Estep, Case Western Reserve University; Eugene H. Blackstone, Case Western Reserve University; Eileen M. Hsich, Case Western Reserve University
• Language: English
• Date: 2023-03-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 by The American Association for Thoracic Surgery
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jtcvs.2021.04.065
• Title of Journal or Parent Work: Journal of Thoracic and Cardiovascular Surgery
• Volume: 165
• Issue: 3
• Start Page: 1111
• End Page: 1121.e12
• Grant/Funding Information: Supported by Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic. Dr Hsich is supported by the National Heart, Lung, and Blood Institute of the National Institute of Health under Award Number HL141892.
• Keywords: SIPAT; mechanical circulatory support; outcome assessment; hospital readmissions; heart transplantation
• Research Categories: Health Sciences, Health Care Management

Abstract

Objective: Left ventricular assist devices require a psychosocial assessment to determine candidacy despite limited data correlating with outcome. Our objective is to determine whether the Stanford Integrated Psychosocial Assessment for Transplant, a tool validated for transplant and widely used by left ventricular assist device programs, predicts left ventricular assist device program hospital readmissions and death. Methods: We performed a retrospective analysis of adults at the Cleveland Clinic with Stanford Integrated Psychosocial Assessment for Transplant scores before primary left ventricular assist device program implantation from April 1, 2013, to December 31, 2018. The primary outcome was unplanned hospital readmissions censored at death, transplantation, and transfer of care. The secondary outcome was death. Results: There were 263 patients in the left ventricular assist device program with a median (Q1, Q3) Stanford Integrated Psychosocial Assessment for Transplant score of 16 (8, 28). During a median follow-up 1.2 years, 56 died, 65 underwent transplantation, and 21 had transferred care. There were 640 unplanned hospital readmissions among 250 patients with at least 1 outpatient visit at our center. In a multivariable analysis, Stanford Integrated Psychosocial Assessment for Transplant components but not total Stanford Integrated Psychosocial Assessment for Transplant score was associated with readmissions. Psychopathology (Stanford Integrated Psychosocial Assessment for Transplant C-IX) was associated with hemocompatibility (coefficient 0.21 ± standard error 0.11, P =.040) and cardiac (0.15 ± 0.065, P =.02) readmissions. Patient readiness was associated with noncardiac (Stanford Integrated Psychosocial Assessment for Transplant A-III, 0.24 ± 0.099, P =.016) and cardiac (Stanford Integrated Psychosocial Assessment for Transplant A-low total, 0.037 ± 0.014, P =.007) readmissions. Poor living environment (Stanford Integrated Psychosocial Assessment for Transplant B-VIII) was associated with device-related readmissions (0.83 ± 0.34, P =.014). Death was associated with organic psychopathology or neurocognitive impairment (Stanford Integrated Psychosocial Assessment for Transplant C-X, 0.59 ± 0.21, P =.006). Conclusions: Total Stanford Integrated Psychosocial Assessment for Transplant score was not associated with left ventricular assist device program readmission or mortality. However, we identified certain Stanford Integrated Psychosocial Assessment for Transplant components that were associated with outcome and could be used to create a left ventricular assist device program specific psychosocial tool.