Depression, Illicit Drug Use Linked To Readmissions After LVAD Placement

Shannon M. Dunlay, M.D. M.S. Advanced Heart Failure and Cardiac Transplantation Assistant Professor of Medicine and Health Care Policy and Research Mayo Clinic RochesterMedicalResearch.com Interview with:
Shannon M. Dunlay, M.D. M.S.
Advanced Heart Failure and Cardiac Transplantation
Assistant Professor of Medicine and Health Care Policy and Research
Mayo Clinic Rochester

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Dunlay: Left ventricular assist devices (LVAD) are increasingly utilized as destination therapy (DT) in patients that are not candidates for heart transplantation. Optimal patient selection is essential in improving outcomes, but many of the factors associated with favorable outcomes remain poorly understood. It is important for us to better understand the role that psychosocial factors may play in outcomes after DT LVAD. Unlike transplant, where the limited organ supply requires choosing candidates with optimal psychosocial characteristics, DT LVAD therapy is more readily available as it does not rely on organ donors. There are no clear guidelines on what constitutes an acceptable psychosocial risk prior to DT LVAD. As a result, many programs will offer DT LVAD to candidates despite psychosocial concerns if it is felt they will otherwise benefit. Data are needed to inform programs about whether such candidates are truly at elevated risk of adverse outcomes.

In our single-center study including 131 patients, we found that several psychosocial characteristics are predictive of readmission after DT LVAD. A history of illegal drug use and depression are associated with a higher risk of readmission, while tobacco use is associated with lower readmission risk. Psychosocial characteristics were not significant predictors of death after DT LVAD.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Dunlay: There are important clinical implications of these data. A thorough assessment of psychosocial characteristics should be an important component of the evaluation and risk stratification of patients for DT LVAD. Patients with a history of depression and illegal drug use are at higher risk for readmission after DT LVAD, and these factors should be considered in risk stratifying patients prior to surgery. It is important to identify such characteristics as medical intervention may lessen the burden and improve patient outcomes.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Dunlay: These findings need replication in larger populations, particularly the associations between psychosocial characteristics and mortality. In addition, further work is needed to understand whether addressing psychosocial factors prior to DT LVAD modifies risk.

Citation:

Are Psychosocial Characteristics Predictive of Death and Rehospitalization After Destination Left Ventricular Assist Device

S.M. Dunlay, Schettle Sharma, S.S. Kushwaha , D.F. Snipelisky, J.S. Stulak

Cardiology, Mayo Clinic, Rochester, MN

Journal of Heart and Lung Transplantation:
DOI: http://dx.doi.org/10.1016/j.healun.2015.01.568

Shannon M. Dunlay, M.D. M.S., Advanced Heart Failure and Cardiac Transplantation, Assistant Professor of Medicine and Health Care Policy and Research,  Mayo Clinic Rochester (2015). Depression, Illicit Drug Use Linked To Readmissions After LVAD Placement 

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