Evaluation of the Stanford Integrated Psychosocial Assessment for Transplantation on Clinical Outcomes Following Left Ventricular Assist Device Implantation

Abstract

<h3>Purpose</h3> The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated psychosocial risk assessment tool widely used in evaluation of heart transplant candidates. We explored its usefulness and re-purposability in predicting post-operative clinical outcomes in the LVAD patient population. <h3>Methods</h3> 145 patients implanted with a durable LVAD at a US tertiary medical center between January 2010 and April 2020 were retrospectively enrolled. Patients were risk-stratified into three groups by SIPAT score based on commonly accepted thresholds of <6 as excellent (31.7%), 6-20 as good (53.8%), and >20 as acceptable/poor (14.5%). <h3>Results</h3> The enrolled patients were predominantly male (68.3%) with a mean age of 54.8 years and mean overall SIPAT score of 12.4. When defined continuously, SIPAT score was not a significant predictor for survival at 1 year (HR, 0.995; 95% CI, 0.927-1.068; P=0.897) or 3 years (HR, 0.989; 95% CI, 0.942-1.039 P=0.666). There was no significant difference in survival between patient groups of different SIPAT strata at 1 year (P=0.888) or 3 years (P=0.743) or in freedom from readmission at 3 years (P=0.389). Additionally, no differences were observed when subgroup analysis was performed by device type. <h3>Conclusion</h3> Several published studies have reported conflicting findings regarding SIPAT's applicability in the LVAD population. In this contemporary single center study, we showed that SIPAT score has no direct correlation to survival or free from readmission following LVAD implantation. Further study may help identify potential contributors (e.g., implementation of a comprehensive patient/family assistance protocol) to the observed enhanced clinical outcome and reduced disparities.