Author + information
- Received March 2, 2020
- Revision received March 19, 2020
- Accepted March 23, 2020
- Published online June 29, 2020.
- Clancy Mullan, MDa,
- Cesar Caraballo, MDb,
- Neal G. Ravindra, MPhilc,
- P. Elliott Miller, MDc,d,
- Megan McCullough, MDe,
- Kelly Brown, MDf,
- Tsung Wai Aw, MDf,
- Jadry Gruen, MDe,
- John-Ross D. Clarke, MBBSg,
- Eric J. Velazquez, MDc,
- Arnar Geirsson, MDa,
- Makoto Mori, MDa,
- Nihar R. Desai, MD, MPHb,c and
- Tariq Ahmad, MD, MPHa,b,∗ (, )@YaleHFdoc
- aDivision of Cardiac Surgery, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- bCenter for Outcomes Research & Evaluation, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- cSection of Cardiovascular Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- dYale National Clinician Scholars Program, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- eDepartment of Internal Medicine, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- fDepartment of Psychiatry, Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- gDepartment of Internal Medicine (Bridgeport Hospital), Yale School of Medicine and Yale New Haven Health, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Tariq Ahmad, Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510.
Background Psychiatric comorbidities play a key role in patient selection for left ventricular assist devices (LVADs), but their impact on clinical outcomes is unknown.
Objectives The goal of this study was to examine the clinical impact of psychiatric illness on outcomes in patients receiving LVADs for end-stage heart failure (HF).
Methods The study identified adults in the Interagency Registry for Mechanically Assisted Circulatory Support with psychiatric comorbidities (history of alcohol abuse, drug use, narcotic dependence, depression, and other major psychiatric diagnoses) receiving continuous-flow LVADs from 2008 to 2017. Demographic characteristics, survival, adverse events, and quality of life scores were compared for patients with and without each psychiatric comorbidity.
Results Over the study period, the prevalence of psychiatric comorbidities was low: alcohol abuse, n = 1,093 (5.5%); drug use, n = 1,077 (5.4%); narcotic dependence, n = 96 (0.5%); depression, n = 401 (2.0%); and other major psychiatric illnesses, n = 265 (1.4%). Narcotic dependence (adjusted hazard ratio: 1.9; 95% confidence interval: 1.2 to 3.0; p = 0.004) and other major psychiatric illnesses (adjusted hazard ratio: 1.4; 95% confidence interval: 1.0 to 1.9; p = 0.02) were associated with increased risk of mortality, whereas alcohol abuse, drug use, and depression were not. All comorbidities except narcotic dependence were associated with increased risk of rehospitalization and device-related infection (both p < 0.05). Kansas City Cardiomyopathy Questionnaire scores were lower from 6 to 24 months’ post-implantation among patients with psychiatric comorbidities (p < 0.05).
Conclusions Despite a low prevalence of psychiatric comorbidities among LVAD recipients, these conditions were associated with mortality risk, adverse events, and poorer quality of life. Further study is needed to understand how specific psychiatric conditions affect outcomes and how to best manage this vulnerable patient population.
This publication was made possible by the Yale National Clinician Scholars Program and by CTSA Grant Number TL1 TR001864 from the National Center for Advancing Translational Science, a component of the National Institutes of Health (Dr. Miller). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. Dr. Desai has been a consultant with Amgen, Boehringer Ingelheim, Cytokinetics, Novartis, Relypsa, and SC Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received March 2, 2020.
- Revision received March 19, 2020.
- Accepted March 23, 2020.
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