Objective: Durable mechanical circulatory support is a proven therapy to extend survival for patients with end-stage heart failure (HF). The International Society for Heart and Lung Transplantation guidelines recommend a detailed psychosocial assessment when selecting candidates for durable mechanical circulatory support. Currently, there are no formally validated psychosocial evaluation tools for left ventricular assist device (LVAD) candidacy. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) uses a multidisciplinary algorithm to evaluate the impact of pre-transplant risk factors on post-transplant outcomes. Emerging literature suggests that the SIPAT might be useful for assessing psychosocial risk factors for LVAD outcomes.
Methods: A total of 268 consecutive patients (median age 66 years, 84.6% male) with terminal HF were evaluated before LVAD implantation with a SIPAT assessment. Key outcomes included readmission and mortality rates at 30 days and two years.
Results: After screening, 234 subjects met the inclusion criteria and were analyzed. The Patient Readiness subscale of the SIPAT was statistically significant in predicting two-year mortality (B = .167, P < .001; Nagelkerke r2 = .106). Scores on the SIPAT did not correlate to 30-day readmission, 30-day mortality, or two-year readmission rates.
Discussion: In this study, only the Patient Readiness score was associated with mortality at two-years post-implantation. This research elucidates the potential longer-term impact of psychosocial factors on LVAD outcomes and the SIPAT’s utility in evaluating LVAD candidacy.
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Chesher, Nicholas; Greenwood, Kristina L.; Fanale, Candace; Gustaveson, Cody; Jaski, Brian; Mehta, Hirsch S.; Hoagland, Peter; Ortiz, Kristine; Verlasky, Marc; Adamson, Robert; and Dembitsky, Walter
"Predicting Left Ventricular Assist Device Outcomes Utilizing the Stanford Integrated Psychosocial Assessment for Transplant Measure,"
The VAD Journal: Vol. 8(1)
Available at: https://digitalcommons.library.tmc.edu/vad/vol8/iss1/12