Ventricular assist devices: a review of psychosocial risk factors and their impact on outcomes.
作者信息
Bruce Courtenay R, Delgado Estevan, Kostick Kristin, Grogan Sherry, Ashrith Guha, Trachtenberg Barry, Estep Jerry D, Bhimaraj Arvind, Pham Linda, Blumenthal-Barby Jennifer S
机构信息
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; Houston Biomedical Ethics Program, Methodist Hospital, Houston, Texas.
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
出版信息
J Card Fail. 2014 Dec;20(12):996-1003. doi: 10.1016/j.cardfail.2014.09.006. Epub 2014 Sep 17.
BACKGROUND
Psychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices. Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices.
METHODS AND RESULTS
We identified 5 studies that examined psychosocial factors and their relationship to postoperative VAD-related outcomes. Our results suggest that 3 psychosocial variables are possibly associated with VAD-related outcomes: depression, functional status, and self-care. Of the few studies that exist, the generalizability of findings is constrained by a lack of methodologic rigor, inconsistent terminology, and a lack of conceptual clarity.
CONCLUSIONS
This review should serve as a call for research. Efforts to minimize psychosocial risk before device placement can only be successful insofar as VAD programs can clearly identify who is at risk for suboptimal outcomes.
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