Value of psychosocial evaluation for left ventricular assist device candidates
| Autor: | Caroline K. Olt, Edward G. Soltesz, Terrence Roncagli, Michael Z. Tong, Aaron J. Weiss, Jerry D. Estep, Eileen Hsich, Alexandra C.W. Sakai, Eugene H. Blackstone, Kay Kendall, Shinya Unai, Lucy Thuita |
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| Rok vydání: | 2023 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart transplantation medicine.medical_specialty business.industry medicine.medical_treatment Living environment 030204 cardiovascular system & hematology Transplantation 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Ventricular assist device Emergency medicine medicine Surgery Cardiology and Cardiovascular Medicine business Neurocognitive Psychosocial Transfer of care Psychopathology |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 165:1111-1121.e12 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2021.04.065 |
| Popis: | Objective Left ventricular assist devices require a psychosocial assessment to determine candidacy despite limited data correlating with outcome. Our objective is to determine whether the Stanford Integrated Psychosocial Assessment for Transplant, a tool validated for transplant and widely used by left ventricular assist device programs, predicts left ventricular assist device program hospital readmissions and death. Methods We performed a retrospective analysis of adults at the Cleveland Clinic with Stanford Integrated Psychosocial Assessment for Transplant scores before primary left ventricular assist device program implantation from April 1, 2013, to December 31, 2018. The primary outcome was unplanned hospital readmissions censored at death, transplantation, and transfer of care. The secondary outcome was death. Results There were 263 patients in the left ventricular assist device program with a median (Q1, Q3) Stanford Integrated Psychosocial Assessment for Transplant score of 16 (8, 28). During a median follow-up 1.2 years, 56 died, 65 underwent transplantation, and 21 had transferred care. There were 640 unplanned hospital readmissions among 250 patients with at least 1 outpatient visit at our center. In a multivariable analysis, Stanford Integrated Psychosocial Assessment for Transplant components but not total Stanford Integrated Psychosocial Assessment for Transplant score was associated with readmissions. Psychopathology (Stanford Integrated Psychosocial Assessment for Transplant C-IX) was associated with hemocompatibility (coefficient 0.21 ± standard error 0.11, P = .040) and cardiac (0.15 ± 0.065, P = .02) readmissions. Patient readiness was associated with noncardiac (Stanford Integrated Psychosocial Assessment for Transplant A-III, 0.24 ± 0.099, P = .016) and cardiac (Stanford Integrated Psychosocial Assessment for Transplant A-low total, 0.037 ± 0.014, P = .007) readmissions. Poor living environment (Stanford Integrated Psychosocial Assessment for Transplant B-VIII) was associated with device-related readmissions (0.83 ± 0.34, P = .014). Death was associated with organic psychopathology or neurocognitive impairment (Stanford Integrated Psychosocial Assessment for Transplant C-X, 0.59 ± 0.21, P = .006). Conclusions Total Stanford Integrated Psychosocial Assessment for Transplant score was not associated with left ventricular assist device program readmission or mortality. However, we identified certain Stanford Integrated Psychosocial Assessment for Transplant components that were associated with outcome and could be used to create a left ventricular assist device program specific psychosocial tool. |
| Databáze: | OpenAIRE |
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