Matthew Cagliostro1, Andrew Bromley1, Peter Ting1, John Donehey2, Bart Ferket3, Kira Parks2, Elyse Palumbo2, Donna Mancini4, Anelechi Anyanwu1, Amit Pawale1, Sean Pinney4, Noah Moss4, Anuradha Lala5. 1. Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Mount Sinai Medical Center, New York, New York. 3. The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York. 5. Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York; The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Anu.lala@mountsinai.org.
Abstract
BACKGROUND: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. METHODS AND RESULTS: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0-2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0-2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96-4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. CONCLUSIONS: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.
BACKGROUND: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. METHODS AND RESULTS: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0-2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0-2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96-4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. CONCLUSIONS: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.
Authors: Ersilia M DeFilippis; Khadijah Breathett; Elena M Donald; Shunichi Nakagawa; Koji Takeda; Hiroo Takayama; Lauren K Truby; Gabriel Sayer; Paolo C Colombo; Melana Yuzefpolskaya; Nir Uriel; Maryjane A Farr; Veli K Topkara Journal: Circ Heart Fail Date: 2020-09-08 Impact factor: 8.790
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Authors: Michelle M Kittleson; Heather Barone; Robert M Cole; Megan Olman; Alisa Fishman; Linda Olanisa; Carmelita Runyan; Jennifer Hajj; Newman Huie; Michael Lindsay; Nancy Sun; Eric Luong; Susan Cheng; Elizabeth Passano; Jon A Kobashigawa; Fardad Esmailian; Danny Ramzy; Jaime D Moriguchi Journal: ASAIO J Date: 2021-04-01 Impact factor: 3.826