SIPAT B Score Predicts Mortality in Both BTT and DT Male LVAD Patients

Abstract

Introduction The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) score assesses psychosocial and behavioral risk in patients who are undergoing evaluation for heart transplant. The SIPAT score is associated with adverse outcomes including increased rates of rejection, admissions and infections post-transplant. Many Stage D heart failure patients will undergo SIPAT testing, with some receiving an LVAD as bridge to transplant (BTT) and other as destination therapy (DT). However, the role of SIPAT scores in left ventricular assist devices (LVAD) patients remains unclear based on a limited number of studies. The objective of this study assesses whether SIPAT scores were associated with increased mortality. Methods SIPAT scores were documented by a Licensed Master Social Worker for 137 LVAD patients (mean age: 50.0±13 years 35.8% female, 59.8% black)including BTT and DT (57.7%) implanted at Emory University Hospital from 2010 to 2018. The total SIPAT score is comprised of 4 subscales that represent different psychosocial domains: A - patient readiness and illness management, B - social support system, C - psychological stability and psychopathology, and D—lifestyle and substance abuse. Multivariable Cox regression models were used to examine the association of SIPAT scores with mortality. Results During a follow-up period of 1.58 years [IQR 0.8-2.87], 53 patients (38.7%) died. The mean total SIPAT score was 7.45 ±8.06, and 92.0% of patients classified as excellent-good candidates (total SIPAT score ≤20). There was no association between total SIPAT scores and mortality in the total cohort. However, the SIPAT B subscale was associated with mortality in men after adjusting for age, race, albumin, and renal function (SIPAT B *sex interaction P=0.009). Men who died had a higher mean score on the SIPAT B subscale than those who did not (2.00 ± 3.65 vs. 0.63 ± 1.63, p=0.05). Sex-stratified Cox models demonstrated that the SIPAT B subscale was associated with mortality in men (adjusted HR: 1.39, 95% CI 1.11-1.75, p=0.004); but not in women (p=0.4). Conclusions In patients with LVAD, the SIPAT B subscale was associated with an increased risk of mortality in men. These findings suggest that social support may play an even greater role for male patients with LVAD as compared to females. More research is needed to determine which factors clearly define the association between social support and mortality in the LVAD population.