TY - JOUR
T1 - Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients
AU - Cagliostro, MATTHEW
AU - BROMLEY, ANDREW
AU - TING, PETER
AU - DONEHEY, J. O.H.N.
AU - FERKET, B. A.R.T.
AU - PARKS, K. I.R.A.
AU - PALUMBO, ELYSE
AU - MANCINI, DONNA
AU - ANYANWU, ANELECHI
AU - PAWALE, A. M.I.T.
AU - PINNEY, S. E.A.N.
AU - MOSS, N. O.A.H.
AU - LALA, ANURADHA
N1 - Publisher Copyright:
© 2019
PY - 2019/9
Y1 - 2019/9
N2 - Background: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and Results: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. Conclusions: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.
AB - Background: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and Results: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. Conclusions: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.
KW - Heart failure
KW - LVAD
KW - Stanford Integrated Psychosocial Assessment for Transplantation
KW - device-associated infections
KW - driveline-associated infection
KW - orthotopic heart transplantation
UR - http://www.scopus.com/inward/record.url?scp=85069043290&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2019.06.006
DO - 10.1016/j.cardfail.2019.06.006
M3 - Article
C2 - 31220624
AN - SCOPUS:85069043290
SN - 1071-9164
VL - 25
SP - 735
EP - 743
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 9
ER -