Bruce Courtenay R, Delgado Estevan, Kostick Kristin, Grogan Sherry, Ashrith Guha, Trachtenberg Barry, Estep Jerry D, Bhimaraj Arvind, Pham Linda, Blumenthal-Barby Jennifer S
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.
J Card Fail. 2014 Dec;20(12):996-1003. doi: 10.1016/j.cardfail.2014.09.006. Epub 2014 Sep 17.
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.
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.
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.
