Utility of the INTERMACS Database on Studying Psychosocial Risk Factors in LVAD Patients

Abstract

<h3>Purpose</h3> Guidelines recommend psychosocial evaluation on all patients undergoing left ventricular assist device (LVAD) evaluation; however, universal criteria have not been established. Lack of universal guidelines makes determining candidacy in high-risk patients difficult and often subjective. Previous studies have utilized the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database to study the impact of high-risk psychosocial factors on outcomes in patients receiving LVADs. We aimed to study the reliability of the INTERMACS database on identifying patients with psychosocial risk factors through comparison with chart review. <h3>Methods</h3> A retrospective review was performed utilizing the INTERMACS database to identify patients with high-risk psychosocial factors prior to LVAD implantation from 2009-2019. Psychosocial factors included history of alcohol abuse, history of illicit substance use disorder, history of repeated non-compliance, and limited social support. Each patient identified as having a high-risk psychosocial factor in the INTERMACS database underwent chart review in the electronic medical record to further evaluate for the presence of these factors prior to implantation. <h3>Results</h3> In the INTERMACS database 89/426 (21%) of patients were noted to have a high-risk psychosocial factor. 45% vs 42.6% had a history of alcohol abuse, 36% vs 18% had a history of substance use disorder, 10% vs 19% had a history of repeated non-compliance, and 18% vs 19% had limited social support when comparing INTERMACS with chart review respectively (Table 1). <h3>Conclusion</h3> The INTERMACS database is an important tool necessary to collect and analyze information in patients who receive LVADs. The discrepancy between INTERMACS data and our chart review illustrates the need for universal psychosocial definitions and increased granularity when collecting psychosocial data when evaluating patients for LVAD implantation to more accurately study their impact on outcomes.