Lower Pre-Implantation Psychosocial Risk Scores Do Not Correlate with Better Survival Following Left Ventricular Assist Device (LVAD) Placement

Abstract

Purpose The assessment of psychosocial risk is an important component in the selection of appropriate candidates for LVAD implementation, however the influence on disease outcome remains poorly studied. In this study, we evaluated the effects of psychosocial risk on mortality, complications, and recurrent admissions. Methods We performed a retrospective chart review of patients with refractory systolic heart failure who underwent LVAD placement between 2009 and 2018 (N=94). The psychosocial risk, ranging low to high (0-4), was determined through assessment of finances, support system, understanding, compliance, substance abuse, mental health, adjustment, and cognition. The primary outcome was overall survival. Secondary outcomes were development of driveline infections, GI bleeds, other bleeds, stroke, thrombus, and readmissions. Results The mean age of patients was 57 years, 74% being male. At the end of 2 years, there were 30 deaths (31.9%). At 6, 12, and 24 months, the patients with the lowest psychosocial risk (score 0) had the highest mortality (P=0.043). The number of psychosocial risk factors that each patient had did not affect survival (P=0.21). For secondary outcomes, psychosocial risk did not correlate with development of strokes, thrombi, other bleeds, or readmissions. Patients with higher risk scores developed less GI bleeds than those with lower scores (P=0.018). Conclusion We found that lower psychosocial risk scores did not correlate with better survival in patients who received an LVAD. However, patients with a low psychosocial risk had significantly worse mortality than other groups. Additionally, there was no correlation between risk score and complications, except GI bleeds, which were significantly higher in patients with lower scores. Given the smaller number of patients who had higher psychosocial risk scores (scores 3 and 4), further studies are required to better understand this association.