Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients

MATTHEW Cagliostro, ANDREW BROMLEY, PETER TING, J. O.H.N. DONEHEY, B. A.R.T. FERKET, K. I.R.A. PARKS, ELYSE PALUMBO, DONNA MANCINI, ANELECHI ANYANWU, Amit Pawale, S. E.A.N. PINNEY, N. O.A.H. MOSS, ANURADHA LALA*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and Results: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. Conclusions: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.

Original languageEnglish (US)
Pages (from-to)735-743
Number of pages9
JournalJournal of Cardiac Failure
Volume25
Issue number9
DOIs
StatePublished - Sep 2019

Fingerprint

Heart-Assist Devices
Transplantation
Confidence Intervals
Ambulatory Care
Hospital Emergency Service
Mortality
Heart Transplantation
Hospitalization
Multivariate Analysis
Psychology
Transplants
Equipment and Supplies
Incidence
Infection

Keywords

  • Heart failure
  • LVAD
  • Stanford Integrated Psychosocial Assessment for Transplantation
  • device-associated infections
  • driveline-associated infection
  • orthotopic heart transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cagliostro, MATTHEW., BROMLEY, ANDREW., TING, PETER., DONEHEY, J. O. H. N., FERKET, B. A. R. T., PARKS, K. I. R. A., ... LALA, ANURADHA. (2019). Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients. Journal of Cardiac Failure, 25(9), 735-743. https://doi.org/10.1016/j.cardfail.2019.06.006
Cagliostro, MATTHEW ; BROMLEY, ANDREW ; TING, PETER ; DONEHEY, J. O.H.N. ; FERKET, B. A.R.T. ; PARKS, K. I.R.A. ; PALUMBO, ELYSE ; MANCINI, DONNA ; ANYANWU, ANELECHI ; Pawale, Amit ; PINNEY, S. E.A.N. ; MOSS, N. O.A.H. ; LALA, ANURADHA. / Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients. In: Journal of Cardiac Failure. 2019 ; Vol. 25, No. 9. pp. 735-743.
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abstract = "Background: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and Results: A total of 115 individuals (mean age: 57 years, 75.6{\%} men) who underwent LVAD implantation, for either bridge-to-transplant (63{\%}) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95{\%} confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95{\%} CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95{\%} CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. Conclusions: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.",
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Cagliostro, MATTHEW, BROMLEY, ANDREW, TING, PETER, DONEHEY, JOHN, FERKET, BART, PARKS, KIRA, PALUMBO, ELYSE, MANCINI, DONNA, ANYANWU, ANELECHI, Pawale, A, PINNEY, SEAN, MOSS, NOAH & LALA, ANURADHA 2019, 'Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients', Journal of Cardiac Failure, vol. 25, no. 9, pp. 735-743. https://doi.org/10.1016/j.cardfail.2019.06.006

Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients. / Cagliostro, MATTHEW; BROMLEY, ANDREW; TING, PETER; DONEHEY, J. O.H.N.; FERKET, B. A.R.T.; PARKS, K. I.R.A.; PALUMBO, ELYSE; MANCINI, DONNA; ANYANWU, ANELECHI; Pawale, Amit; PINNEY, S. E.A.N.; MOSS, N. O.A.H.; LALA, ANURADHA.

In: Journal of Cardiac Failure, Vol. 25, No. 9, 09.2019, p. 735-743.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients

AU - Cagliostro, MATTHEW

AU - BROMLEY, ANDREW

AU - TING, PETER

AU - DONEHEY, J. O.H.N.

AU - FERKET, B. A.R.T.

AU - PARKS, K. I.R.A.

AU - PALUMBO, ELYSE

AU - MANCINI, DONNA

AU - ANYANWU, ANELECHI

AU - Pawale, Amit

AU - PINNEY, S. E.A.N.

AU - MOSS, N. O.A.H.

AU - LALA, ANURADHA

PY - 2019/9

Y1 - 2019/9

N2 - Background: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and Results: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. Conclusions: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.

AB - Background: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and Results: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. Conclusions: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.

KW - Heart failure

KW - LVAD

KW - Stanford Integrated Psychosocial Assessment for Transplantation

KW - device-associated infections

KW - driveline-associated infection

KW - orthotopic heart transplantation

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Cagliostro MATTHEW, BROMLEY ANDREW, TING PETER, DONEHEY JOHN, FERKET BART, PARKS KIRA et al. Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients. Journal of Cardiac Failure. 2019 Sep;25(9):735-743. https://doi.org/10.1016/j.cardfail.2019.06.006