Ventricular Assist Devices: A Review of Psychosocial Risk Factors and Their Impact on Outcomes |
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| Affiliation: | 1. Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas;2. Houston Biomedical Ethics Program, Methodist Hospital, Houston, Texas;3. Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas;4. Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas;5. Weill Cornell Medical College, New York, New York;1. Department of Cardiology, Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark;2. Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota;3. Department of Biochemistry, Rigshospitalet and University of Aarhus, Aarhus, Denmark;1. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden;2. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden;1. Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina;2. Department of Epidemiology and Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia;3. Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina;4. Department of Health Policy and Management, University of North Carolina at Chapel Hill, North Carolina;5. Departments of Population Health and Medicine, New York University, New York, New York;6. Department of Medicine, University of Mississippi, Jackson, Mississippi;1. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio;2. Department of Mathematics, Cleveland State University, Cleveland, Ohio;3. Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio;1. Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center, Ljubljana, Slovenia;2. Department of Intensive Care Medicine, University Medical Center, Ljubljana, Slovenia;3. Institute of Physiology, University of Ljubljana School of Medicine, Ljubljana, Slovenia;4. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California;1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria;2. Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands;3. Department of Cardiology and Pneumology, University of Goettingen, Goettingen, Germany;4. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria;5. Coordination Center for Clinical Trials, University of Leipzig, Leipzig, Germany;6. Department of Cardiology, Charité-Universitätsmedizin Berlin, Germany;7. Department of Cardiology, Medical University of Graz, Austria;8. Brahms, Hennigsdorf, Germany;9. Synlab Center of Laboratory Diagnostics, Heidelberg, Germany;10. Mannheim Institute of Public Health, Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim, Germany |
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| Abstract: | ![]()
BackgroundPsychosocial 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 ResultsWe 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.ConclusionsThis 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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| Keywords: | LVAD depression ambulation frailty self-care outcomes |
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