Division of Cardiology, Department of Medicine (E.M. DeFilippis, E.M. Donald, G.S., P.C.C., M.Y., N.U., M.A.F., V.K.T.), Columbia University College of Physicians and Surgeons, New York, NY.
Division of Cardiovascular Medicine, Department of Medicine, Sarver Heart Center, University of Arizona, Tucson (K.B.).
Circ Heart Fail. 2020 Sep;13(9):e006910. doi: 10.1161/CIRCHEARTFAILURE.120.006910. Epub 2020 Sep 8.
Advanced heart failure therapies such as left ventricular assist device (LVAD) implantation require intricate follow-up and complex care. We sought to explore the burden of psychosocial risk factors among patients with LVAD and their impact on postimplant outcomes using the Interagency Registry for Mechanically Assisted Circulatory Support.
Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support requiring durable LVAD between 2008 and 2017 were included. Individuals were determined to have psychosocial risk if they had one of the following: (1) limited social support; (2) limited cognition; (3) substance abuse (alcohol and drug); (4) severe psychiatric disease (including major depression and other major psychiatric diagnosis); and (5) repeated noncompliance. Univariate and multivariate Cox proportional hazard regression models were used to analyze predictors of survival and complications.
A total of 15 403 continuous-flow LVAD recipients were included. A total of 3163 (20.5%) had one or more psychosocial risk factors. The most prevalent psychosocial risk factor was substance abuse in 1941 (12.6%) recipients. Patients with psychosocial risk factors were significantly younger at LVAD implant, less likely to be White, and less likely to be female compared with those without psychosocial risk, <0.001 for all. Patients with psychosocial risk were significantly more likely to receive an LVAD as destination therapy, <0.001. In adjusted models, patients with psychosocial risk were at increased hazards for device-related infection, gastrointestinal bleeding, pump thrombosis, and readmission and reduced hazards for cardiac transplantation (<0.05 for all). There was no statistically significant difference in survival on pump support or stroke.
Psychosocial risk is an important component of patient selection for advanced heart failure therapies. Addressing these specific components may help improve access to advanced therapies and post-LVAD outcomes.
左心室辅助装置（LVAD）植入等先进的心衰治疗方法需要复杂的随访和复杂的护理。我们试图利用机械循环辅助支持机构间注册中心，探讨 LVAD 患者的心理社会风险因素负担及其对植入后结局的影响。
纳入 2008 年至 2017 年期间需要永久性 LVAD 的机械循环辅助支持机构间注册中心的成年患者。如果患者有以下情况之一，则确定存在心理社会风险：（1）社会支持有限；（2）认知能力有限；（3）物质滥用（酒精和药物）；（4）严重精神疾病（包括重度抑郁症和其他主要精神诊断）；以及（5）反复不遵守医嘱。采用单变量和多变量 Cox 比例风险回归模型分析生存和并发症的预测因素。
共纳入 15403 例连续血流 LVAD 受者。共有 3163 例（20.5%）存在 1 种或多种心理社会风险因素。最常见的心理社会风险因素是 1941 例（12.6%）患者的物质滥用。与无心理社会风险因素的患者相比，有心理社会风险因素的患者 LVAD 植入时年龄明显较小，白人比例较低，女性比例较低，<0.001。有心理社会风险的患者更有可能接受 LVAD 作为终末期治疗，<0.001。在调整后的模型中，有心理社会风险的患者在器械相关感染、胃肠道出血、泵血栓形成和再入院方面的风险增加，而在心脏移植方面的风险降低（<0.05）。在泵支持或中风方面，生存率无统计学差异。
心理社会风险是选择晚期心衰治疗患者的一个重要组成部分。解决这些具体问题可能有助于改善获得先进治疗方法和 LVAD 后结局的机会。
