J Heart Lung Transplant. 2023 Jun 26:S1053-2498(23)01920-4. doi: 10.1016/j.healun.2023.06.013. Online ahead of print.
ABSTRACT
BACKGROUND: Reasons for women’s increased probability to experience adverse events (AEs) after left ventricular assist device (LVAD) implantation compared with men’s remain uncertain. We explored the role of psychosocial risk in the experience of AEs in women and men.
METHODS: INTERMACS patients receiving a primary continuous-flow LVAD between 7/2006 and 12/2017, median follow-up 13.6 months, were included (n=20123, 21.3% women). Time-to-event was calculated with cumulative incidence functions for 10 types of AEs separately (e.g., infection, device malfunction), each time accounting for the competing outcomes death, heart transplant and device explant due to recovery. Event-specific Cox proportional hazard models were run with a binary psychosocial risk variable (including: substance abuse, psychiatric diagnoses, limited social support, limited cognition, repeated noncompliance), controlled for covariates.
RESULTS: Psychosocial risk was more prevalent in men than in women (21.4% vs. 17.5%, p <.001). Seven out of ten AEs were more likely in women than in men (e.g., infection 44.5% vs. 39.2%, p <.001). The association of psychosocial risk with each AE was either stronger in women than in men (e.g., device malfunction HRadj 1.29, 95% CI [1.06-1.56] vs. HRadj 1.10, 95% CI [0.97-1.25]; rehospitalization HRadj 1.15, 95% CI [1.02-1.29] vs. HRadj 1.03, 95% CI [0.97-1.10]) or similar between sexes.
CONCLUSIONS: Independent of clinical parameters, the presence of psychosocial risk is associated with increases in AEs. This suggests that early modification of psychosocial risk factors may have the potential to lower the risk for AEs in this patient population.
PMID:37380090 | DOI:10.1016/j.healun.2023.06.013
