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Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study.
J Heart Lung Transplant 2012; 31(1):16-26JH

Abstract

BACKGROUND

Medical and psychosocial factors are related to 1-year outcomes in the Waiting for a New Heart Study. With increased use of mechanical circulatory support devices (MCSD) over the course of the study, we can now evaluate these variables as predictors of MCSD in an extended follow-up.

METHODS

Analyses focused on 313 MCSD-free patients (82% men; aged 53 ± 11 years) newly listed for heart transplantation (HTx). Variables assessed at time of listing included psychosocial risk (depression, social isolation), quality of life, waiting list stress, and medical risk (Heart Failure Survival Score, pulmonary capillary wedge pressure). Cumulative incidence functions and cause-specific Cox models examined the association of medical and psychosocial risk (low: non-depressed and socially integrated; medium: depressed or socially isolated; high: depressed and socially isolated) with time until MCSD, considering covariates and competing outcomes (death, high-urgency transplantation [HU-HTx], elective HTx, and delisting due to clinical improvement or deterioration).

RESULTS

Psychosocial risk groups were comparable regarding demographics, medical parameters, and quality of life, but differed in waiting list-related stressors. During follow-up (median, 326; range, 5-1,849 days), 26 patients received MCSD, 53 died, 144 underwent HTx (103 in HU status), and 53 were delisted (15 deteriorated, 31 improved). Non-depressed and socially integrated patients did not require MCSD. Controlling for medical risk, psychosocial risk significantly contributed to MCSD, HU-HTx, and improvement; medical risk and female gender predicted death (p < 0.05).

CONCLUSIONS

Psychosocial risk at time of listing affects the prognosis of HTx candidates beyond medical risk. Psychosocial interventions may help to stabilize patients' health.

Authors+Show Affiliations

Department of Psychology, Johannes Gutenberg-University, Mainz, Germany. spaderna@uni-mainz.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21959123

Citation

Spaderna, Heike, et al. "Medical and Psychosocial Predictors of Mechanical Circulatory Support Device Implantation and Competing Outcomes in the Waiting for a New Heart Study." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 31, no. 1, 2012, pp. 16-26.
Spaderna H, Weidner G, Koch KC, et al. Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study. J Heart Lung Transplant. 2012;31(1):16-26.
Spaderna, H., Weidner, G., Koch, K. C., Kaczmarek, I., Wagner, F. M., & Smits, J. M. (2012). Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 31(1), pp. 16-26. doi:10.1016/j.healun.2011.07.018.
Spaderna H, et al. Medical and Psychosocial Predictors of Mechanical Circulatory Support Device Implantation and Competing Outcomes in the Waiting for a New Heart Study. J Heart Lung Transplant. 2012;31(1):16-26. PubMed PMID: 21959123.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study. AU - Spaderna,Heike, AU - Weidner,Gerdi, AU - Koch,Karl-Christian, AU - Kaczmarek,Ingo, AU - Wagner,Florian M, AU - Smits,Jacqueline M A, AU - ,, Y1 - 2011/10/01/ PY - 2011/04/12/received PY - 2011/06/16/revised PY - 2011/07/28/accepted PY - 2011/10/1/entrez PY - 2011/10/1/pubmed PY - 2012/5/2/medline SP - 16 EP - 26 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 31 IS - 1 N2 - BACKGROUND: Medical and psychosocial factors are related to 1-year outcomes in the Waiting for a New Heart Study. With increased use of mechanical circulatory support devices (MCSD) over the course of the study, we can now evaluate these variables as predictors of MCSD in an extended follow-up. METHODS: Analyses focused on 313 MCSD-free patients (82% men; aged 53 ± 11 years) newly listed for heart transplantation (HTx). Variables assessed at time of listing included psychosocial risk (depression, social isolation), quality of life, waiting list stress, and medical risk (Heart Failure Survival Score, pulmonary capillary wedge pressure). Cumulative incidence functions and cause-specific Cox models examined the association of medical and psychosocial risk (low: non-depressed and socially integrated; medium: depressed or socially isolated; high: depressed and socially isolated) with time until MCSD, considering covariates and competing outcomes (death, high-urgency transplantation [HU-HTx], elective HTx, and delisting due to clinical improvement or deterioration). RESULTS: Psychosocial risk groups were comparable regarding demographics, medical parameters, and quality of life, but differed in waiting list-related stressors. During follow-up (median, 326; range, 5-1,849 days), 26 patients received MCSD, 53 died, 144 underwent HTx (103 in HU status), and 53 were delisted (15 deteriorated, 31 improved). Non-depressed and socially integrated patients did not require MCSD. Controlling for medical risk, psychosocial risk significantly contributed to MCSD, HU-HTx, and improvement; medical risk and female gender predicted death (p < 0.05). CONCLUSIONS: Psychosocial risk at time of listing affects the prognosis of HTx candidates beyond medical risk. Psychosocial interventions may help to stabilize patients' health. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/21959123/Medical_and_psychosocial_predictors_of_mechanical_circulatory_support_device_implantation_and_competing_outcomes_in_the_Waiting_for_a_New_Heart_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(11)01083-7 DB - PRIME DP - Unbound Medicine ER -