Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools-including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale-were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.

中文翻译：

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心脏移植和心室辅助装置候选人的社会心理评估：目前的共识之外。

由于捐献者的匮乏，费用高昂和护理负担大，有限的患者可以使用先进的心力衰竭疗法，包括心脏移植和持久的机械循环支持。在晚期心力衰竭中强调了健康的心理和社会决定因素的重要性，包括认知状态，健康素养，心理病理学，社会支持，医疗依从性和药物滥用，并在机械循环支持和心脏移植的背景下得到了进一步的发展。晚期心力衰竭治疗候选人的社会心理评估仍然是主观的，需要多学科评估，其中可能包括精神科医生，社会工作者，病例管理员，财务协调员，药剂师和临床医生。在有限的人群中开发并验证了客观工具，包括斯坦福大学用于移植的综合社会心理评估，对候选人的社会心理评估以及移植评估等级量表，以帮助标准化评估过程。小型回顾性研究不一致地表明，这些工具可能会预测移植人群的临床结局，且与再次入院，排斥反应发作和感染相关的风险分数更高。但是，要证明这些工具可以预测死亡率更加困难，而对其在机械循环支持人群中的适用性的研究还很少。国际心脏和肺移植学会在2018年发布了一项共识声明，以促进跨高级心力衰竭计划的社会心理评估的一致性，但鉴于当前的证据状态，它缺乏具体的建议。这项最新的综述通过批判性地审查支持现有客观评估工具的当前研究，提出了一种使用多学科方法的社会心理评估框架并为研究提供了未来的方向，从而扩展了当前的共识。