Poor Social Support Confers Worse Survival after MCS

Abstract

Patient selection for mechanical circulatory support (MCS) therapy remains challenging. Psychosocial factors such as psychiatric disorders and poor social support, have been found to be associated with outcomes post heart transplant. Research exploring the impact of such factors on LVAD outcomes is limited. We explored the relationship between psychosocial factors and outcomes following implantation with MCS. We completed a retrospective chart review of 87 consecutive patients who completed a social work and psychological evaluation prior to durable MCS. Those not surviving to discharge were excluded. Psychosocial variables were tested for association with overall survival using Cox regression models adjusted for age, MSC type, and device intent. Mean patient age was 57±1.3 years, 37% were African American with median [25th, 75th] support time of 9.5 [4.5,16] months. On univariable analysis, poor social support correlated (Fig 1a) with mortality, with non-significant trends towards those living alone and with non-compliance (Fig 1b) (table). On multivariable regression, poor social support had a marked influence on mortality, most notable after 6 months of support (Hazard Ratio= 0.08, p=0.029, Fig 1a). Poor social support was independently associated with worse outcome after MCS with a very high hazard for early mortality. Important trends were noted to suggest risk in those living alone and with poor compliance. The presence of a dedicated support person/team to assist with the demands of MCS maintenance and close outpatient coordinator clinic and telephone follow-up may help improve outcomes. Larger sample pending acceptance.