Psychosocial Characteristics and Outcomes in Patients with Ventricular Assist Device

Abstract

Purpose Patient selection for durable ventricular assist device (VAD) involves a comprehensive medical and psychosocial evaluation. Although there are guidelines for evaluation of medical comorbidities, psychosocial risk assessment remains somewhat subjective. There is ongoing concern that patients may be denied VAD due to perceived high-risk psychosocial characteristics that may not impact survival after VAD implantation. The purpose of this study was to evaluate the patient psychosocial risk profile and its impact on outcomes after VAD implantation. Methods This study was a single center, retrospective analysis of 93 patients who underwent durable VAD implantation at Advocate Christ Medical Center in 2016. Psychosocial factors on outcomes were evaluated using the Student's t-test, Fischer's exact test, and one-way analysis of variance. Results Of 93 patients, mean age was 55 ± 13 years, 73% were males, 46% were African American, 69% had non-ischemic cardiomyopathy, and 60% received destination therapy. Most prevalent psychosocial factors were: 27% had a pre-existing psychiatric diagnosis, 53% were not married, 22% had no children, 11% lived alone, 19% did not complete a high school education, 26% were chronically unemployed, 55% formerly abused tobacco, 13% formerly abused alcohol, and 24% formerly abused illicit drug. Mean days on device was 589 ± 321, mean number of readmissions within the first year was 2.5 ± 2.6, and mean number of days to first readmission was 80 ± 91. Those with less than a high school education were 55% more likely to experience an adverse event (driveline infection, bacteremia, stroke, hemolysis, GI bleed, other bleed) compared to those with a graduate level education (p Conclusion These results suggest that certain psychosocial factors may not influence mortality or adverse event rates after VAD implantation. Although, education level impacted adverse event rates, further delineation is required. A larger sample size is needed to elucidate exactly which psychosocial characteristics affect VAD outcomes.