The Impact of a High-risk Psychosocial Assessment on Outcomes After Durable Mechanical Circulatory Support.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 04 2021
01 04 2021
Historique:
pubmed:
3
8
2020
medline:
1
6
2021
entrez:
3
8
2020
Statut:
ppublish
Résumé
Patient adherence is vital to the success of durable mechanical circulatory support (MCS), and the pre-MCS assessment of adherence by the multidisciplinary advanced heart failure team is a critical component of the evaluation. We assessed the impact of a high-risk psychosocial assessment before durable MCS implantations on post-MCS outcomes. Between January 2010 and April 2018, 319 patients underwent durable MCS at our center. We excluded those who died or were transplanted before discharge. The remaining 203 patients were grouped by pre-MCS psychosocial assessment: high-risk (26; 12.8%) versus acceptable risk (177; 87.2%). We compared clinical characteristics, nonadherence, and outcomes between groups. High-risk patients were younger (48 vs. 56; p = 0.006) and more often on extracorporeal membrane oxygenation at durable MCS placement (26.9% vs. 9.0%; p = 0.007). These patients had a higher incidence of post-MCS nonadherence including missed clinic appointments, incorrect medication administration, and use of alcohol and illicit drugs. After a mean follow-up of 15.3 months, 100% of high-risk patients had unplanned hospitalizations compared with 76.8% of acceptable-risk patients. Per year, high-risk patients had a median of 2.9 hospitalizations per year vs. 1.2 hospitalizations per year in acceptable-risk patients. While not significant, there were more driveline infections over the follow-up period in high-risk patients (27% vs. 14.7%), deaths (27% vs. 18%), and fewer heart transplants (53.8% vs. 63.8%).The pre-MCS psychosocial assessment is associated with post-MCS evidence of nonadherence and unplanned hospitalizations. Attention to pre-MCS assessment of psychosocial risk factors is essential to optimize durable MCS outcomes.
Identifiants
pubmed: 32740124
pii: 00002480-202104000-00013
doi: 10.1097/MAT.0000000000001229
pmc: PMC8100754
mid: NIHMS1688790
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
436-442Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL131532
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL142983
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL143227
Pays : United States
Informations de copyright
Copyright © ASAIO 2020.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest or sources of funding to report.
Références
McMurray JJ. Clinical practice. Systolic heart failure. N Engl J Med. 362:228–238, 2010
Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 36:1080–1086, 2017
Feldman D, Pamboukian SV, Teuteberg JJ, et al. International Society for Heart and Lung TransplantationThe 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 32:157–187, 2013
Sperry BW, Ikram A, Alvarez PA, et al. Standardized psychosocial assessment before left ventricular assist device implantation. Circ Heart Fail. 12:e0053772019
Lundgren S, Lowes BD, Zolty R, et al. Do psychosocial factors have any impact on outcomes after left ventricular assist device implantation? ASAIO J. 64:e43–e47, 2018
Halkar M, Nowacki AS, Kendall K, et al. Utility of the psychosocial assessment of candidates for transplantation in patients undergoing continuous-flow left ventricular assist device implantation. Prog Transplant. 28:220–225, 2018
Yost GL, Bhat G, Ibrahim KN, Karountzos AG, Chandrasekaran M, Mahoney E. Psychosocial evaluation in patients undergoing left ventricular assist device implantation using the transplant evaluation rating scale. Psychosomatics. 57:41–46, 2016
Cagliostro M, Bromley A, Ting P, et al. Standardized use of the stanford integrated psychosocial assessment for transplantation in LVAD patients. J Card Fail. 25:735–743, 2019
Gandhi J, McCue A, Cole R. Nonadherence in the advanced heart failure population. Curr Heart Fail Rep. 13:77–85, 2016
Tan NY, Sangaralingham LR, Schilz SR, Dunlay SM. Longitudinal heart failure medication use and adherence following left ventricular assist device implantation in privately insured patients. J Am Heart Assoc. 6:e0057762017
Hugtenburg JG, Timmers L, Elders PJ, Vervloet M, van Dijk L. Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Prefer Adherence. 7:675–682, 2013
Lampropulos JF, Kim N, Wang Y, et al. Trends in left ventricular assist device use and outcomes among Medicare beneficiaries, 2004-2011. Open Heart. 1:e0001092014
Cogswell R, Smith E, Hamel A, et al. Substance abuse at the time of left ventricular assist device implantation is associated with increased mortality. J Heart Lung Transplant. 33:1048–1055, 2014
Sindone AP, Keogh AM, Macdonald PS, McCosker CJ, Kaan AF. Continuous home ambulatory intravenous inotropic drug therapy in severe heart failure: safety and cost efficacy. Am Heart J. 134Pt 1889–900, 1997
Hershberger RE, Nauman D, Walker TL, Dutton D, Burgess D. Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure. J Card Fail. 9:18x0–187, 2003