From the Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Cardiovascular Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
ASAIO J. 2018 Jul/Aug;64(4):e43-e47. doi: 10.1097/MAT.0000000000000736.
Psychosocial factors have been show to impact survival and outcomes in a number of different diseases, including heart failure and patients receiving heart transplantation. With the increasing utilization of these devices, it is important to identify risk factors that could impact post-left ventricular assist device (LVAD) outcomes. This study was a single center, retrospective analysis of 238 patients who underwent implantation of a LVAD between July 27, 2004, and July 21, 2016, at The University of Nebraska Medical Center. Data collected include length of stay, number of readmission, alive status at 30 days, 180 days, and 1 year, as well as multiple psychosocial factors including history of drug abuse, history of alcohol abuse, history of noncompliance, history of anxiety, and history of depression, among others. Outcomes were calculated using univariate and multivariate analyses with SAS Version 9.4. None of the psychosocial factors assessed in this study showed statistical significance in predicting 30 day or 6 month mortality, but patients who smoked at the time of admission for LVAD implantation had higher mortality at 1 year (odds ratio 4.6, 95% confidence interval, 1.226-15.898, p = 0.011.) Patients with a diagnosis of depression had higher numbers of readmissions compared with those without depression (p = 0.048) with the number of readmissions further increased in patients with a diagnosis of both depression and anxiety (p = 0.0074). Psychosocial determinants do not appear to have a significant effect on mortality, but can result in increased risk of readmission if not adequately addressed before implantation and continually monitored postimplantation.
社会心理因素已被证明会影响多种疾病的存活和结局，包括心力衰竭和接受心脏移植的患者。随着这些设备的应用越来越广泛，确定可能影响左心室辅助装置（LVAD）术后结果的风险因素非常重要。这项研究是对 2004 年 7 月 27 日至 2016 年 7 月 21 日在内布拉斯加大学医学中心接受 LVAD 植入术的 238 名患者进行的单中心回顾性分析。收集的数据包括住院时间、再入院次数、术后 30 天、180 天和 1 年的存活情况，以及包括药物滥用史、酒精滥用史、不遵医嘱史、焦虑史和抑郁史在内的多个社会心理因素。使用 SAS 版本 9.4 进行单变量和多变量分析来计算结果。本研究评估的社会心理因素均与 30 天或 6 个月死亡率无统计学意义，但在接受 LVAD 植入术时吸烟的患者在 1 年内死亡率更高（比值比 4.6，95%置信区间 1.226-15.898，p=0.011）。与无抑郁的患者相比，被诊断为抑郁症的患者再入院次数更多（p=0.048），而同时被诊断为抑郁症和焦虑症的患者再入院次数进一步增加（p=0.0074）。社会心理因素似乎对死亡率没有显著影响，但如果在植入前未得到充分解决并在植入后持续监测，可能会增加再入院的风险。
