Value of Psychosocial Evaluation for Left Ventricular Assist Device Candidates

Abstract Objective Left ventricular assist devices (LVAD) require a psychosocial assessment to determine candidacy despite limited data correlating with outcome. Our objective is to determine whether Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), a tool validated for transplant and widely used by LVAD programs, predicts LVAD hospital readmissions and death. Methods Retrospective analysis of adults at Cleveland Clinic with SIPAT scores prior to primary LVAD implantation from 4/1/2013 –12/31/2018. Primary outcome was unplanned hospital readmissions censored at death, transplantation, and transfer of care. Secondary outcome was death. Results There were 263 LVAD patients with median (Q1,Q3) SIPAT score of 16 (8,28). During a median follow-up 1.2 years, 56 died, 65 transplanted and 21 transferred care. There were 640 unplanned hospital readmissions among 250 patients with at least one outpatient visit at our center. In a multivariable analysis, SIPAT components but not total SIPAT score was associated with readmissions. Psychopathology (SIPAT C-IX) was associated with hemocompatability (Coefficient 0.21 +/- SE 0.11, P=0.040) and cardiac (0.15 +/- 0.065, P=0.02) readmissions. Patient readiness was associated with non-cardiac (SIPAT A-III, 0.24 +/-0.099, P=0.016) and cardiac (SIPAT A-low total, 0.037+/-0.014, P=0.007) readmissions. Poor living environment (SIPAT B-VIII) was associated with device-related readmissions (0.83 +/-0.34, P=0.014). Death was associated with organic psychopathology or neurocognitive impairment (SIPAT C-X, 0.59 +/- 0.21, P= 0.006). Conclusion Total SIPAT score was not associated with LVAD readmission or mortality. However, we identified certain SIPAT components that were associated with outcome and could be used to create a LVAD specific psychosocial tool.