Choi Joy J, Bhasin Shreya, Levstik Johannes, Walsh Patrick, Oldham Mark A, Lee Hochang Benjamin
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
Gen Hosp Psychiatry. 2024 Sep-Oct;90:132-140. doi: 10.1016/j.genhosppsych.2024.08.007. Epub 2024 Aug 20.
Psychosocial assessment is a core component of the multidisciplinary evaluation for left ventricular assist device (LVAD) implantation. The degree to which psychosocial conditions are considered a contraindication to LVAD implantation continues to be debated. This systematic review examines modifiable psychosocial factors as predictors of outcomes in patients undergoing LVAD implantation.
We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search resulted in 2509 articles. After deduplication, abstract and full-text review, 20 relevant articles were identified.
Included studies evaluated socioeconomic status (n = 6), caregiver characteristics (n = 6), non-adherence (n = 6), substance use (n = 13), and psychiatric disorder (n = 8). The most commonly measured outcomes were all-cause death, readmission rate, and adverse events. Studies varied widely in definition of each psychosocial factor and selected outcomes. No psychosocial factor was consistently associated with a specific outcome in all studies. Socioeconomic status was generally not associated with outcomes. Non-adherence, psychiatric disorder, and substance use were associated with higher risks of mortality, adverse events, and/or readmission. Findings on caregiver characteristics were mixed.
Of the psychosocial factors studied, non-adherence, psychiatric disorder, and substance use were the most consistently associated with an increased risk of mortality, readmission, and/or adverse events. Heterogeneity in research methodology and study quality across studies precludes firm conclusions regarding the impact of psychosocial factors on long-term patient outcomes. The results of this review reveal a need for adequately powered studies that use uniform definitions of psychosocial factors to clarify relationships between these factors and outcomes after LVAD implantation.
心理社会评估是左心室辅助装置（LVAD）植入多学科评估的核心组成部分。心理社会状况被视为LVAD植入禁忌证的程度仍存在争议。本系统评价旨在研究可改变的心理社会因素作为LVAD植入患者预后的预测因素。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了系统评价。检索结果为2509篇文章。经过去重、摘要和全文审查，确定了20篇相关文章。
纳入研究评估了社会经济状况（n = 6）、照顾者特征（n = 6）、不依从性（n = 6）、物质使用（n = 13）和精神障碍（n = 8）。最常测量的结局是全因死亡、再入院率和不良事件。各心理社会因素的定义和所选结局在研究中差异很大。在所有研究中，没有一种心理社会因素与特定结局始终相关。社会经济状况一般与结局无关。不依从性、精神障碍和物质使用与更高的死亡、不良事件和/或再入院风险相关。关于照顾者特征的研究结果不一。
在所研究的心理社会因素中，不依从性、精神障碍和物质使用与死亡、再入院和/或不良事件风险增加最一致相关。各研究在研究方法和研究质量上的异质性妨碍了就心理社会因素对患者长期预后的影响得出确凿结论。本评价结果表明，需要开展有足够样本量的研究，采用统一的心理社会因素定义，以阐明这些因素与LVAD植入后结局之间的关系。
