Psychosocial characteristics and outcomes in patients with left ventricular assist device implanted as destination therapy

David Snipelisky, John M. Stulak, Sarah D. Schettle, Shashank Sharma, Sudhir S. Kushwaha, Shannon M Dunlay

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Psychosocial factors impact survival in patients undergoing cardiac transplantation, but it is unclear whether they affect outcomes in patients undergoing left ventricular assist device (LVAD) implantation as destination therapy (DT). Methods Patients undergoing DT LVAD at the Mayo Clinic in Rochester, MN, from February 2007 to December 2013 were included. Psychosocial characteristics at the time of LVAD implantation were abstracted from the medical record. Andersen-Gill and Cox models were used to examine the association between psychosocial characteristics and all-cause readmission and death, respectively. Patients were censored at death or last follow-up through September 2014. Results Among 136 patients (mean age. 64 years; 17% female), most were married/living with a partner (82%), half (55%) had post-high school education, and a history of depression was common (32%). Although most patients were former tobacco users (60%) only a small proportion were current tobacco users (10%) and had a history of alcohol abuse (16%) or illegal drug use (7%). After a mean follow-up of 2.2 ± 1.8 years, 78% of patients had been readmitted (range, 0-14 per person) and 49% had died. There were no statistically significant differences in the risk of death according to psychosocial characteristics. However, current tobacco users had lower risk of readmission (adjusted HR, 0.57; 95% CI, 0.38-0.88), while illegal drug use (HR, 1.55; 95% CI, 1.01-2.35) and depression (HR, 1.77; 95% CI, 1.40-2.22) were associated with higher readmission risk. Conclusions Psychosocial characteristics are not significant predictors of death but are associated with readmission risk after DT LVAD.

Original languageEnglish (US)
Pages (from-to)887-894
Number of pages8
JournalAmerican Heart Journal
Volume170
Issue number5
DOIs
StatePublished - 2015

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Heart-Assist Devices
Tobacco
Therapeutics
Depression
Heart Transplantation
Proportional Hazards Models
Pharmaceutical Preparations
Alcoholism
Medical Records
Cause of Death
Psychology
Education
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Psychosocial characteristics and outcomes in patients with left ventricular assist device implanted as destination therapy. / Snipelisky, David; Stulak, John M.; Schettle, Sarah D.; Sharma, Shashank; Kushwaha, Sudhir S.; Dunlay, Shannon M.

In: American Heart Journal, Vol. 170, No. 5, 2015, p. 887-894.

Research output: Contribution to journalArticle

Snipelisky, David ; Stulak, John M. ; Schettle, Sarah D. ; Sharma, Shashank ; Kushwaha, Sudhir S. ; Dunlay, Shannon M. / Psychosocial characteristics and outcomes in patients with left ventricular assist device implanted as destination therapy. In: American Heart Journal. 2015 ; Vol. 170, No. 5. pp. 887-894.
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abstract = "Background Psychosocial factors impact survival in patients undergoing cardiac transplantation, but it is unclear whether they affect outcomes in patients undergoing left ventricular assist device (LVAD) implantation as destination therapy (DT). Methods Patients undergoing DT LVAD at the Mayo Clinic in Rochester, MN, from February 2007 to December 2013 were included. Psychosocial characteristics at the time of LVAD implantation were abstracted from the medical record. Andersen-Gill and Cox models were used to examine the association between psychosocial characteristics and all-cause readmission and death, respectively. Patients were censored at death or last follow-up through September 2014. Results Among 136 patients (mean age. 64 years; 17{\%} female), most were married/living with a partner (82{\%}), half (55{\%}) had post-high school education, and a history of depression was common (32{\%}). Although most patients were former tobacco users (60{\%}) only a small proportion were current tobacco users (10{\%}) and had a history of alcohol abuse (16{\%}) or illegal drug use (7{\%}). After a mean follow-up of 2.2 ± 1.8 years, 78{\%} of patients had been readmitted (range, 0-14 per person) and 49{\%} had died. There were no statistically significant differences in the risk of death according to psychosocial characteristics. However, current tobacco users had lower risk of readmission (adjusted HR, 0.57; 95{\%} CI, 0.38-0.88), while illegal drug use (HR, 1.55; 95{\%} CI, 1.01-2.35) and depression (HR, 1.77; 95{\%} CI, 1.40-2.22) were associated with higher readmission risk. Conclusions Psychosocial characteristics are not significant predictors of death but are associated with readmission risk after DT LVAD.",
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N2 - Background Psychosocial factors impact survival in patients undergoing cardiac transplantation, but it is unclear whether they affect outcomes in patients undergoing left ventricular assist device (LVAD) implantation as destination therapy (DT). Methods Patients undergoing DT LVAD at the Mayo Clinic in Rochester, MN, from February 2007 to December 2013 were included. Psychosocial characteristics at the time of LVAD implantation were abstracted from the medical record. Andersen-Gill and Cox models were used to examine the association between psychosocial characteristics and all-cause readmission and death, respectively. Patients were censored at death or last follow-up through September 2014. Results Among 136 patients (mean age. 64 years; 17% female), most were married/living with a partner (82%), half (55%) had post-high school education, and a history of depression was common (32%). Although most patients were former tobacco users (60%) only a small proportion were current tobacco users (10%) and had a history of alcohol abuse (16%) or illegal drug use (7%). After a mean follow-up of 2.2 ± 1.8 years, 78% of patients had been readmitted (range, 0-14 per person) and 49% had died. There were no statistically significant differences in the risk of death according to psychosocial characteristics. However, current tobacco users had lower risk of readmission (adjusted HR, 0.57; 95% CI, 0.38-0.88), while illegal drug use (HR, 1.55; 95% CI, 1.01-2.35) and depression (HR, 1.77; 95% CI, 1.40-2.22) were associated with higher readmission risk. Conclusions Psychosocial characteristics are not significant predictors of death but are associated with readmission risk after DT LVAD.

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