Maukel Lisa-Marie, Schmeller Sandra, Weidner Gerdi, Beyersmann Jan, Spaderna Heike
Department of Health Psychology, Trier University, 54296 Trier, Germany.
Institute of Statistics, Ulm University, 89081 Ulm, Germany.
J Cardiovasc Dev Dis. 2025 May 22;12(6):198. doi: 10.3390/jcdd12060198.
Women experience higher rates of adverse events and first rehospitalization after left ventricular assist device (LVAD) implantation compared with men. This study investigated the role of sex and preimplant psychosocial risk in recurrent hospitalizations.
Data from 20,123 INTERMACS patients (21.3% women) were analyzed. Cumulative transition rates (e.g., home to hospitalization) were estimated and Andersen-Gill models, adjusted for covariates, examined the association between sex, preimplant psychosocial risk, and cumulative transition hazards for rehospitalization. State occupation probabilities, the mean number of hospitalizations, and the cumulative average length of hospital stay were calculated and stratified by sex and psychosocial risk.
Psychosocial risk preimplant was more prevalent in men than in women (21.4% vs. 17.5%, < 0.001). The interaction of female sex and psychosocial risk increased rehospitalization hazards, independently of covariates [HR 1.11, 95% CI (1.01-1.22), = 0.036]. One-year postimplant, women with vs. without psychosocial risk had 2.2 vs. 1.8 hospitalizations, while men experienced 1.8 vs. 1.7 hospitalizations, respectively. Women with vs. without psychosocial risk spent 20 vs.16 days hospitalized, and men 15 vs. 14 days (all < 0.001).
Preimplant psychosocial risk independently contributed to recurrent hospitalizations post-LVAD, particularly affecting women. The early identification and management of these factors may reduce rehospitalizations and improve clinical outcomes.
与男性相比，女性在植入左心室辅助装置（LVAD）后发生不良事件和首次再住院的几率更高。本研究调查了性别和植入前心理社会风险在再住院中的作用。
分析了20123例INTERMACS患者（21.3%为女性）的数据。估计累积转移率（如从家到住院），并使用经协变量调整的安德森-吉尔模型，研究性别、植入前心理社会风险与再住院累积转移风险之间的关联。计算状态占用概率、平均住院次数和累积平均住院时间，并按性别和心理社会风险进行分层。
植入前心理社会风险在男性中比在女性中更普遍（21.4%对17.5%，<0.001）。女性性别与心理社会风险的相互作用增加了再住院风险，独立于协变量[风险比1.11，95%置信区间（1.01-1.22），=0.036]。植入后一年，有心理社会风险的女性与无心理社会风险的女性住院次数分别为2.2次和1.8次，而男性分别为1.8次和1.7次。有心理社会风险的女性与无心理社会风险的女性住院时间分别为20天和16天，男性为15天和14天（均<0.001）。
植入前心理社会风险独立导致LVAD植入后再住院，对女性影响尤为明显。对这些因素的早期识别和管理可能会减少再住院次数并改善临床结局。
