The impact of psychiatric diagnoses on two-year outcomes in patients with ventricular assist devices

Abstract

Background A multi-specialty approach is required during patient selection for left ventricular assist device (LVAD) implantation. In addition to a comprehensive medical evaluation, patients undergo an extensive psychiatric work up to ensure their candidacy when pursuing durable support devices. We aim to analyze the impact of psychiatric illnesses on 2-year outcomes after VAD implantation. Methods This study was a single center, retrospective analysis of 263 patients who underwent durable LVAD implantation between 2015 and 2017. All patients were evaluated by a single specialist during their work up for LVAD implantation. Patients who had a pre-existing diagnosis defined by criteria outlined in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were assigned to the History of Psychiatric Diagnosis group. Statistical analysis was performed using Chi-Square and Student's t-tests, wherein p<0.05 was considered statistically significant. Results Of the 263 patients, 68 patients were found to have a history of psychiatric illness compared to 195 who had no previous diagnosis. Of those with a psychiatric history, 30.8% had Depression, 1.5% had Bipolar disorder, 22.1% had Anxiety, 1.5% had PTSD, and 16.2% had more than one diagnosis. 19.5% of patients with no history went on to be transplanted compared to 22.1% of patients with a psychiatric history (p=0.65). No significant difference was found between length of stay, days to readmission, 30-day survival, and 2-year survival. Patients without a psychiatric history were found to have fewer number of readmissions over 2 years (p<0.01) (See Table). No significant difference was seen in complications including driveline infections, bacteremia, cerebrovascular accidents, pump thromboses, pump hemolysis, or major bleeding events (See Table). Conclusion Psychosocial characteristics play a significant role in determining a patient's candidacy for LVAD implantation. Although patients with a history of psychiatric illness were found to have a greater number of readmissions, this did not correlate to poorer outcomes or increased morbidity and mortality over 2 years. This study highlights the importance of taking a multi-faceted approach when determining patient eligibility for mechanical support devices. Future studies with larger population models should be conducted. FUNDunding Acknowledgement Type of funding sources: None.

A new opportunity for patient selection and optimization: Systematic review of cognitive frailty in patients undergoing left ventricular assist device implantation

“…Of a total of 664 reviewed articles, 12 studies qualified to be included in the systematic review 3,11–21 . Of these, 8 were retrospective analyses, while 4 were prospective studies.…”

“…21 Other clinical outcomes that were associated with increased cognitive frailty determined by MoCA were increased intubations, 18 time in the intensive care unit, 19 increased LOS, 18 and pump hemolysis. 21 There are also conflicting data when comparing cognition and LVAD outcomes when using other measures of frailty. Pavol and colleagues demonstrated that low cognition scores, as measured by separate attention, memory, mental flexibility, and visual construction tests, were associated with less days alive outside of the hospital (representing readmission rates) 3 as well as death.…”

“…Of the studies that used the MoCA, patients with low MoCA scores were found to have worse survival at 1 year after LVAD placement in some studies, 14,16,19,20 while others using the MoCA demonstrated an unclear relationship with mortality. 21 Other clinical outcomes that were associated with increased cognitive frailty determined by MoCA were increased intubations, 18 time in the intensive care unit, 19 increased LOS, 18 and pump hemolysis. 21 There are also conflicting data when comparing cognition and LVAD outcomes when using other measures of frailty.…”

“…Of a total of 664 reviewed articles, 12 studies qualified to be included in the systematic review. 3,[11][12][13][14][15][16][17][18][19][20][21] Of these, 8 were retrospective analyses, while 4 were prospective studies. There was some inconsistency with the means by which cognitive frailty was assessed in these studies.…”