Background:Before consideration of advanced cardiac therapies, guidelines recommend a comprehensive multidisciplinary examination, including psychosocial assessment. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) has emerged as a highly reproducible tool to assess for psychosocial impairment and is associated with negative medical and psychosocial outcomes after transplantation. We sought to assess the association between SIPAT and outcomes after left ventricular assist device.Methods and Results:We evaluated 128 patients implanted with a first left ventricular assist device at the Cleveland Clinic from 2013 to 2017 who underwent a prospectively collected quantitative psychosocial assessment using SIPAT. Several survival analyses were performed testing the association between SIPAT score and mortality, first adverse event (defined as hospitalization, device exchange, or death), and recurring adverse events after multivariable adjustment. Median SIPAT score was 14 (interquartile range, 9.5–22.5), with higher values (representing more impairment) seen in patients implanted as destination therapy. After a median follow-up of 349 (interquartile range, 178–684) days, there were 319 adverse events (18 deaths, 10 device exchanges, and 291 readmissions) with 2.5±2.4 events per patient. Higher preimplant SIPAT scores were not associated with mortality (P=0.764) or time to a first adverse event (P=0.589) but were associated with cumulative adverse events (hazard ratio, 1.31; 95% CI, 1.09–1.58; P=0.005 per Δ10 in score). In addition, SIPAT was associated with days alive outside of the hospital (P=0.016).Conclusions:A standardized assessment of psychosocial impairment after left ventricular assist device using the SIPAT score was not associated with mortality or time to first adverse event but was associated with cumulative adverse cardiac events. This score may provide insight when structuring mitigation strategies for high-risk patients and should be further tested in a prospective multicenter study.

中文翻译：

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左心室辅助装置植入前的标准化社会心理评估

背景：在考虑采用先进的心脏疗法之前，指南建议进行全面的多学科检查，包括社会心理评估。斯坦福大学移植的综合社会心理评估（SIPAT）已成为评估社会心理损害的一种高度可重复的工具，并与移植后的医学和社会心理负面结果相关。方法和结果：我们评估了2013年至2017年在克利夫兰诊所植入了第一台左心室辅助装置的128例患者，这些患者接受了使用SIPAT进行的前瞻性收集的定量社会心理评估。 。进行了几项生存分析，以测试SIPAT得分与死亡率之间的关系，首次不良事件（定义为住院，设备更换或死亡），以及经过多变量调整后的复发性不良事件。SIPAT评分的中位数为14（四分位间距为9.5-22.5），在植入作为目的地疗法的患者中，其SIPAT得分较高（代表更大的损伤）。中位随访349天（四分位间距178-684天）后，发生了319次不良事件（18例死亡，10次更换器械和291例再次入院），每例患者发生2.5±2.4次。较高的植入前SIPAT分数与死亡率无关（中位随访349天（四分位间距178-684天）后，发生了319次不良事件（18例死亡，10次更换器械和291例再次入院），每例患者发生2.5±2.4次。较高的植入前SIPAT分数与死亡率无关（中位随访349天（四分位间距178-684天）后，发生了319次不良事件（18例死亡，10次更换器械和291例再次入院），每例患者发生2.5±2.4次。较高的植入前SIPAT分数与死亡率无关（P = 0.764）或首次发生不良事件的时间（P = 0.589），但与累积不良事件相关（危险比，1.31； 95％CI，1.09–1.58；P = 0.005，每Δ10得分）。此外，SIPAT与医院外的存活天数相关（P = 0.016）。结论：使用SIPAT评分对左心室辅助装置术后的心理社会损害进行标准化评估与死亡率或首次发生不良事件的时间无关，但与累积不良心脏事件。该分数在为高风险患者制定缓解策略时可能会提供见识，因此应在前瞻性多中心研究中进行进一步测试。