Ventricular Assist Devices: A Review of Psychosocial Risk Factors and Their Impact on Outcomes

- Psychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices.
- Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes?
- We identified a recurring problem associated with a lack of conceptual distinctions for quality of life and physical function, resulting in an uncertainty about how these factors influence psychosocial dimensions.
- We hope to encourage the development of consensus statements concerning conceptual and operational definitions of psychosocial domains.
- We also hope to encourage the development of a research agenda aimed at providing consistent and transparent patient selection processes that are treatment specific.

BackgroundPsychosocial contraindications for ventricular assist devices (VADs) remain particularly nebulous and are driven by institution-specific practices. Our multi-institutional, multidisciplinary workgroup conducted a review with the goal of addressing the following research question: How are preoperative psychosocial domains predictive of or associated with postoperative VAD-related outcomes? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices.Methods and ResultsWe identified 5 studies that examined psychosocial factors and their relationship to postoperative VAD-related outcomes. Our results suggest that 3 psychosocial variables are possibly associated with VAD-related outcomes: depression, functional status, and self-care. Of the few studies that exist, the generalizability of findings is constrained by a lack of methodologic rigor, inconsistent terminology, and a lack of conceptual clarity.ConclusionsThis review should serve as a call for research. Efforts to minimize psychosocial risk before device placement can only be successful insofar as VAD programs can clearly identify who is at risk for suboptimal outcomes.