222 - SIPAT Scale May be Valuable in Psychosocial Assessment of LVAD Candidates

Abstract

Background: Psychosocial predictors of LVAD outcomes have not been standardized. There is limited data on objective psychosocial predictors of LVAD outcomes. The SIPAT (Stanford Integrated Psychosocial Assessment for Transplant) scale has been validated in organ transplant evaluation and patient selection. A SIPAT score of less than 20 suggests an acceptable candidate, a SIPAT score of between 20–40 suggests a minimally acceptable candidate, and a SIPAT score of greater than 40 suggests a poor candidate. We hypothesized that SIPAT scale can be used in psychosocial risk assessment of VAD candidates. Methods: We retrospectively reviewed and identified patients evaluated for LVAD since January 2014 and subsequently deemed to be poor candidates for LVAD therapy. Retrospective SIPAT scores were performed on these patients. We divided patients turned down for LVAD based on medical risk factors and social risk factors. Scoring was based on evaluations by licensed clinical and medical social workers. Results: Among all patients who did not receive a VAD (n = 54), 31 had a complete LVAD evaluation. Of these, 13 were deemed to be at high psychosocial risk and were declined specifically for psychosocial reasons. These patients had mean SIPAT 31. Subscore A (measure of insight, motivation, compliance) was the greatest contributor to the total score. By comparison with other non-candidates, patients turned down for LVAD for psychosocial concerns tended to be non-white (71% vs 41%), not married (65% vs 24%), younger, were less likely to have pursued post-secondary education (24% vs 57%), and were predominantly considered for DT VAD (82% vs 54%). Conclusions: Psychosocial risk factors for LVAD therapy have not been standardized and may differ from heart transplant risk factors. We found a high percentage of patients who were turned down for LVAD were declined explicitly for psychosocial risk factors. The average SIPAT score in these patients was 31, in the minimally acceptable range. The SIPAT score may not be sensitive enough for psychosocial risk assessment of VAD candidates.