Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation

Jeffrey Wang; Alexis K Okoh; Yuxuan Chen; Rebecca S Steinberg; Apoorva Gangavelli; Krishan J Patel; Yi-An Ko; Jeffrey D Alexis; Shivani A Patel; David J Vega; Mani Daneshmand; Ersilia M Defilippis; Khadijah Breathett; Alanna A Morris

doi:10.1016/j.cardfail.2024.03.011

Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation

J Card Fail. 2024 Apr 15:S1071-9164(24)00120-9. doi: 10.1016/j.cardfail.2024.03.011. Online ahead of print.

Affiliations

¹ Emory University School of Medicine, Division of Cardiology, Atlanta, GA.
² Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA.
³ University of Rochester Medical Center, Division of Cardiology, Rochester, NY.
⁴ Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA.
⁵ Emory University School of Medicine, Department of Surgery, Atlanta, GA.
⁶ Center for Advanced Cardiac Care, Columbia University Irving Medical Center, Division of Cardiology, New York, NY.
⁷ Indiana University School of Medicine, Division of Cardiology, Indianapolis, IN.
⁸ Emory University School of Medicine, Division of Cardiology, Atlanta, GA. Electronic address: aamorr3@emory.edu.

PMID: 38621441
DOI: 10.1016/j.cardfail.2024.03.011

Abstract

Background: Among patients with advanced heart failure (HF), treatment with a left ventricular assist device (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL and outcomes after LVAD implantation.

Methods: A retrospective cohort (n = 9832) of adults aged ≥ 19 years who received durable LVADs between 2008 and 2017 was identified by using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Patients were considered to have psychosocial risk factors if ≥ 1 of the following were present: (1) substance abuse; (2) limited social support; (3) limited cognitive understanding; (4) repeated nonadherence; and (5) major psychiatric disease. Multivariable logistic and linear regression models were used to evaluate the association between psychosocial risk factors and change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores from baseline to 1 year, persistently poor HRQOL (KCCQ-12 score < 45 at baseline and 1 year), and 1-year rehospitalization.

Results: Among the final analytic cohort, 2024 (20.6%) patients had ≥ 1 psychosocial risk factors. Psychosocial risk factors were associated with a smaller improvement in KCCQ-12 scores from baseline to 1 year (mean ± SD, 29.1 ± 25.9 vs 32.6 ± 26.1; P = 0.015) for a difference of -3.51 (95% confidence interval [CI]: -5.88 to -1.13). Psychosocial risk factors were associated with persistently poor HRQOL (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.04-1.74), and 1-year all-cause readmission (adjusted hazard ratio [aHR] 1.11, 95% CI 1.05-1.18). Limited social support, major psychiatric disorder and repeated nonadherence were associated with persistently poor HRQOL, while major psychiatric disorder was associated with 1-year rehospitalization.

Conclusion: The presence of psychosocial risk factors is associated with lower KCCQ-12 scores and higher risk for readmission at 1 year after LVAD implantation. These associations are statistically significant, but further research is needed to determine whether these differences are clinically meaningful.