The Stanford Integrated Psychosocial Assessment for Transplantation Score Predicts Frequency of Hospital Readmissions in Left Ventricular Assist Device Patients

Abstract

Purpose The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) score is a validated tool for determination of psychosocial and behavioral risk in patients who are undergoing evaluation for organ transplant. The total score is comprised of subsets A-D which scores patient's readiness level and illness management, social support system, psychological stability, as well as lifestyle and effect of substance abuse, respectively. Several centers use SIPAT scores to determine suitability of Left Ventricular Assist Device (LVAD) candidates, however SIPAT remains an unvalidated risk assessment tool in this population. The objective of this study is to assess whether SIPAT scores are associated with 1-year hospital readmissions in LVAD patients. Methods SIPAT scores were documented for 121 LVAD patients (mean age: 50.5 years, 36 % female, 56% black, 45% BTT) implanted at Emory University Hospital from 2010 to 2018. Zero inflated poisson regression models were used to examine the association of SIPAT scores and subscales with the number of hospital readmissions within the 1st year after LVAD implantation, adjusted for age, sex, race, INTERMACS profile, BTT versus DT status, eGFR, and albumin. Results The mean total SIPAT score was 7.07 ±7.76, with mean scores on the subscales as follows: SIPAT A:0.94 ± 2.05, SIPAT B:0.98 ± 2.47, SIPAT C:1.42 ± 2.41, SIPAT D:3.63 ± 3.74. In the first year after LVAD implantation, 259 total hospitalizations occurred in 106 patients (87.6% of total patients had at least 1 admission and there were 16 deaths). The total SIPAT score was associated with a higher number of 1-year hospital readmissions with an adjusted HR: 1.02 for 1-point increase in score (95% CI: 1.00-1.04, p=0.012). Specifically, SIPAT A (adjusted HR: 1.12( 95% CI: 1.06-1.21, p Conclusion In LVAD patients, the total SIPAT score, driven by subscales A and D, was associated with an increased risk of 1-year hospital readmissions following LVAD implantation. These findings suggest that these scores may be useful in risk stratifying LVAD patients and highlight the population of patients who require additional support.