Abstract 15090: At-Risk Financial Status is Associated With Less Favorable Outcomes in Patients With Left Ventricular Assist Devices

Abstract

Background: Few studies have investigated the impact of psychosocial determinants in patients with left ventricular assist devices (LVADs). Methods: We conducted a single-institution, retrospective review of patients hospitalized for index LVAD implant (January 2013 to July 2019). Patients underwent a comprehensive psychosocial evaluation conducted by certified clinical transplant social workers. Each evaluation included psychosocial determinants of health: Psychiatric illness, Compliance, Substance abuse, Family support, Level of understanding, Adequate housing/transportation, and financial status . Factors such as financial status carried their separate scoring grade (0-4 scale); patients scoring 0 were counted as ‘high-risk,’ while those scoring >3 (adequate income) were low-risk (Table 1). Results: Of 330 patients, 211 had comprehensive psychosocial risk assessment, while the others had abbreviated assessments due to acuity. A total of 93 patients had eventual death after device implantation. Maximum follow-up was 3280 days. Financial status showed significant association with survival on univariate Cox-regression analysis. Those with inadequate finances had lower survival (P = .014; Figure 1). On multivariate Cox-regression analysis, the impact of financial status on survival decreased. Conclusions: Socioeconomic assessments of patients eligible for LVADs are important, and further analysis is needed to identify relationships between psychosocial determinants and outcomes. Identification of specific causal relationships that predict worse outcomes in this patient population will benefit the field.