Courtenay R Bruce1, Estevan Delgado2, Kristin Kostick2, Sherry Grogan3, Guha Ashrith4, Barry Trachtenberg4, Jerry D Estep4, Arvind Bhimaraj4, Linda Pham3, Jennifer S Blumenthal-Barby2. 1. Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; Houston Biomedical Ethics Program, Methodist Hospital, Houston, Texas. Electronic address: crbruce@bcm.edu. 2. Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas. 3. Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. 4. Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College, New York, New York.
Abstract
BACKGROUND: Psychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices. Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices. METHODS AND RESULTS: We identified 5 studies that examined psychosocial factors and their relationship to postoperative VAD-related outcomes. Our results suggest that 3 psychosocial variables are possibly associated with VAD-related outcomes: depression, functional status, and self-care. Of the few studies that exist, the generalizability of findings is constrained by a lack of methodologic rigor, inconsistent terminology, and a lack of conceptual clarity. CONCLUSIONS: This review should serve as a call for research. Efforts to minimize psychosocial risk before device placement can only be successful insofar as VAD programs can clearly identify who is at risk for suboptimal outcomes.
BACKGROUND:Psychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices. Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices. METHODS AND RESULTS: We identified 5 studies that examined psychosocial factors and their relationship to postoperative VAD-related outcomes. Our results suggest that 3 psychosocial variables are possibly associated with VAD-related outcomes: depression, functional status, and self-care. Of the few studies that exist, the generalizability of findings is constrained by a lack of methodologic rigor, inconsistent terminology, and a lack of conceptual clarity. CONCLUSIONS: This review should serve as a call for research. Efforts to minimize psychosocial risk before device placement can only be successful insofar as VAD programs can clearly identify who is at risk for suboptimal outcomes.
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