Unmarried Left Ventricular Assist Device (LVAD) Recipients Are More Likely To Experience Adverse Events

Abstract

Purpose Candidates for LVAD have varying degrees of social support. The effect of marital status (MS) on outcomes in these patients is unknown. We hypothesized that being married is associated with less risk of adverse events. Methods and Materials 151 consecutive Heartmate II LVAD implants at our center surviving index hospitalization were reviewed for MS at time of implant, implant date, strategy (DT vs BTT), IMACS class, age, race, and sex. A subset of 89 patient had full INTERMACS followup event data. Cox proportional hazards model for time to death, any event, and individual events was performed, censoring for transplant and adjusting for age, IMACS class, and strategy. Results 66.2% of patients were married. Married patients had lesser hazard for mortality, any event, and each component event. After adjustment this effect was significant for mortality, rehospitalization, infection, and neurologic events. At 12 months, 19.6% of unmarried vs 8% of married patients had died (p =0.04). [ figure 1 ] Conclusions Unmarried LVAD recipients are at greater risk of adverse events after the index hospitalization. This likely reflects the social support advantages of marriage. In unmarried patients, other means of social support should be closely assessed. Hazard Ratio - Married vs Unmarried Event Unadjusted HR (95% CI) Adjusted HR * (95% CI) Death† 0.61 (0.34-1.10) 0.47 (0.23-0.93) Any Even ♦ 0.49 (0.29-0.84) 0.58 (0.32-1.05) Rehospitalization ♦ 0.45 (0.26-0.78) 0.52 (0.28-0.96) Infection ♦ 0.37 (0.19-0.74) 0.44 (0.21-0.90) Neurologic Event ♦ 0.06 (0.01-0.48) 0.05 (0.01-0.61) Bleeding ♦ 0.57 (0.15-2.12) 0.61 (0.15-2.52) Device Failure ♦ 0.30 (0.07-1.36) 0.38 (0.10-2.44) * Adjusted for Age, IMACS class, Strategy †N=151 survivors of index hosp. ♦ N=89 subset with INTERMACS all-events data