Table 2.
Hazard Ratio Estimates for LVAD Outcomes by Psychosocial Risk
| LVAD Outcomes | Unadjusted Cox Regression | Adjusted Cox Regression* | ||
|---|---|---|---|---|
| HR (95% CI) | p-value | HR (95% CI) | p-value | |
| Survival on pump support | ||||
| Any Psychosocial Risk | 0.84 (0.77 – 0.92) | <0.001 | 0.99 (0.91 – 1.09) | 0.902 |
| Limited Social Support | 0.90 (0.77 – 1.05) | 0.182 | 0.96 (0.81 – 1.13) | 0.608 |
| Limited Cognition | 0.81 (0.63 – 1.05) | 0.107 | 0.84 (0.64 – 1.11) | 0.213 |
| Substance Abuse | ||||
| ETOH Abuse | 0.82 (0.72 – 0.93) | 0.002 | 0.96 (0.84 – 1.10) | 0.533 |
| Drug Use | 0.68 (0.59 – 0.79) | <0.001 | 0.97 (0.83 – 1.14) | 0.703 |
| Psychiatric Disease | ||||
| Severe Depression | 0.89 (0.72 – 1.10) | 0.272 | 0.95 (0.76 – 1.19) | 0.653 |
| Other Major Psychiatric Dx | 1.08 (0.85 – 1.37) | 0.529 | 1.38 (1.07 – 1.77) | 0.012 |
| Non-Compliance | 0.94 (0.78 – 1.13) | 0.515 | 1.16 (0.95 – 1.40) | 0.137 |
| Cardiac Transplantation | ||||
| Any Psychosocial Risk | 0.82 (0.76 – 0.90) | <0.001 | 0.85 (0.80 – 0.91) | <0.001 |
| Limited Social Support | 0.68 (0.57 – 0.81) | <0.001 | 0.82 (0.68 – 0.99) | 0.038 |
| Limited Cognition | 0.67 (0.51 – 0.89) | 0.005 | 0.66 (0.49 – 0.89) | 0.006 |
| Substance Abuse | ||||
| ETOH Abuse | 0.93 (0.83 – 1.05) | 0.249 | 0.88 (0.77 – 0.99) | 0.041 |
| Drug Use | 0.95 (0.84 – 1.07) | 0.392 | 0.84 (0.74 – 0.96) | 0.011 |
| Psychiatric Disease | ||||
| Severe Depression | 0.82 (0.66 – 1.01) | 0.066 | 0.81 (0.64 – 1.02) | 0.068 |
| Other Major Psychiatric Dx | 1.12 (0.88 – 1.41) | 0.357 | 1.10 (0.86 – 1.41) | 0.444 |
| Non-Compliance | 0.62 (0.50 – 0.78) | <0.001 | 0.68 (0.54 – 0.86) | 0.001 |
| Device Related Infection | ||||
| Any Psychosocial Risk | 1.40 (1.28 – 1.54) | <0.001 | 1.29 (1.17 – 1.43) | <0.001 |
| Limited Social Support | 1.57 (1.35 – 1.84) | <0.001 | 1.44 (1.22 – 1.69) | <0.001 |
| Limited Cognition | 1.22 (0.94 – 1.59) | 0.132 | 1.22 (0.92 – 1.61) | 0.161 |
| Substance Abuse | ||||
| ETOH Abuse | 1.30 (1.14 – 1.49) | <0.001 | 1.26 (1.09 – 1.45) | 0.002 |
| Drug Use | 1.43 (1.25 – 1.63) | <0.001 | 1.24 (1.07 – 1.44) | 0.004 |
| Psychiatric Disease | ||||
| Severe Depression | 1.22 (0.97 – 1.53) | 0.083 | 1.12 (0.88 – 1.42) | 0.345 |
| Other Major Psychiatric Dx | 1.62 (1.26 – 2.08) | <0.001 | 1.46 (1.12 – 1.90) | 0.006 |
| Non-Compliance | 1.58 (1.31 – 1.90) | <0.001 | 1.37 (1.13 – 1.67) | 0.002 |
| Gastrointestinal Bleeding | ||||
| Any Psychosocial Risk | 0.98 (0.90 – 1.06) | 0.532 | 1.20 (1.11 – 1.31) | <0.001 |
| Limited Social Support | 0.96 (0.82 – 1.11) | 0.555 | 1.06 (0.91 – 1.24) | 0.467 |
| Limited Cognition | 1.13 (0.91 – 1.05) | 0.267 | 1.24 (0.99 – 1.56) | 0.058 |
| Substance Abuse | ||||
| ETOH Abuse | 1.02 (0.90 – 1.14) | 0.794 | 1.22 (1.08 – 1.38) | 0.002 |
| Drug Use | 0.74 (0.65 – 0.85) | <0.001 | 1.08 (0.93 – 1.24) | 0.325 |
| Psychiatric Disease | ||||
| Severe Depression | 1.08 (0.89 – 1.30) | 0.432 | 1.26 (1.03 – 1.53) | 0.023 |
| Other Major Psychiatric Dx | 0.88 (0.68 – 1.13) | 0.319 | 1.17 (0.90 – 1.53) | 0.223 |
| Non-Compliance | 1.10 (0.93 – 1.31) | 0.250 | 1.40 (1.17 – 1.67) | <0.001 |
| Device Thrombosis (Suspected or Confirmed) | ||||
| Any Psychosocial Risk | 1.27 (1.14 – 1.41) | <0.001 | 1.19 (1.06 – 1.33) | 0.002 |
| Limited Social Support | 1.27 (1.05 – 1.53) | 0.013 | 1.19 (0.98 – 1.45) | 0.087 |
| Limited Cognition | 1.10 (0.81 – 1.50) | 0.544 | 1.06 (0.77 – 1.47) | 0.723 |
| Substance Abuse | ||||
| ETOH Abuse | 1.05 (0.89 – 1.24) | 0.539 | 1.08 (0.91 – 1.29) | 0.363 |
| Drug Use | 1.37 (1.18 – 1.60) | <0.001 | 1.19 (1.01 – 1.41) | 0.038 |
| Psychiatric Disease | ||||
| Severe Depression | 1.40 (1.10 – 1.77) | 0.006 | 1.27 (0.99 – 1.63) | 0.061 |
| Other Major Psychiatric Dx | 1.57 (1.19 – 2.07) | 0.002 | 1.37 (1.01 – 1.85) | 0.042 |
| Non-Compliance | 1.43 (1.16 – 1.77) | <0.001 | 1.29 (1.03 – 1.62) | 0.024 |
| Stroke (Ischemic or Hemorrhagic) | ||||
| Any Psychosocial Risk | 1.02 (0.92 – 1.12) | 0.765 | 1.11 (0.99 – 1.24) | 0.067 |
| Limited Social Support | 0.97 (0.80 – 1.17) | 0.726 | 0.98 (0.80 – 1.20) | 0.846 |
| Limited Cognition | 1.00 (0.75 – 1.35) | 0.959 | 0.96 (0.70 – 1.32) | 0.788 |
| Substance Abuse | ||||
| ETOH Abuse | 1.01 (0.87 – 1.18) | 0.853 | 1.15 (0.98 – 1.35) | 0.084 |
| Drug Use | 0.89 (0.76 – 1.05) | 0.169 | 1.00 (0.84 – 1.19) | 0.976 |
| Psychiatric Disease | ||||
| Severe Depression | 0.88 (0.67 – 1.15) | 0.349 | 0.89 (0.67 – 1.18) | 0.420 |
| Other Major Psychiatric Dx | 1.12 (0.83 – 1.51) | 0.467 | 1.15 (0.84 – 1.59) | 0.380 |
| Non-Compliance | 1.28 (1.04 – 1.56) | 0.018 | 1.38 (1.11 – 1.71) | 0.004 |
| Hospital Readmission | ||||
| Any Psychosocial Risk | 1.08 (1.03 – 1.13) | 0.002 | 1.14 (1.08 – 1.19) | <0.001 |
| Limited Social Support | 1.06 (0.98 – 1.15) | 0.169 | 1.13 (1.04 – 1.24) | 0.005 |
| Limited Cognition | 1.00 (0.87 – 1.14) | 0.948 | 1.09 (0.94 – 1.26) | 0.263 |
| Substance Abuse | ||||
| ETOH Abuse | 1.06 (0.99 – 1.14) | 0.071 | 1.11 (1.03 – 1.19) | 0.005 |
| Drug Use | 1.03 (0.96 – 1.11) | 0.373 | 1.09 (1.01 – 1.17) | 0.022 |
| Psychiatric Disease | ||||
| Severe Depression | 1.20 (1.07 – 1.33) | 0.001 | 1.18 (1.06 – 1.33) | 0.004 |
| Other Major Psychiatric Dx | 1.42 (1.25 – 1.62) | <0.001 | 1.40 (1.22 – 1.60) | <0.001 |
| Non-Compliance | 1.04 (0.94 – 1.15) | 0.439 | 1.10 (0.99 – 1.22) | 0.085 |
ETOH = alcohol
*
Adjusted for age, gender, race, BSA, implant year, HF etiology, RVAD use, pump type (axial vs. centrifugal), INTERMACS Class, device strategy (destination vs. bridge), creatinine, bilirubin, and albumin levels.