Social isolation and depression predict 12-month outcomes in the "waiting for a new heart study".
BACKGROUND
Identification of modifiable psychosocial characteristics related to survival of heart transplant (HTx) candidates is needed to prevent clinical deterioration and improve prognosis.


METHODS
A multi-site, prospective study was conducted with 318 HTx candidates (18% female, 82% male; 53 +/- 11 years of age) newly listed at 17 hospitals in Germany and Austria. Baseline demographic and psychosocial characteristics were assessed by questionnaires. Indicators of disease severity (Heart Failure Survival Score, creatinine, cardiac index) and 12-month outcomes (death, high-urgency HTx, elective HTx, de-listing due to deterioration or improvement) were provided by Eurotransplant.


RESULTS
By 12 months, 33 patients died, 83 received an urgent HTx, 30 underwent an elective HTx, and 9 were de-listed due to clinical deterioration and 17 due to improvement. All measures of disease severity predicted outcomes. Controlling for disease severity, the number of social contacts contributed significantly to outcomes, favoring those who improved. Comparing socially isolated patients (<4 social contacts/month) who also had depression scores in the clinical range (high psychosocial risk group; n = 37) to those with >10 social contacts/month without depression (low psychosocial risk group; n = 47) revealed significant differences in the distribution of outcome frequencies (chi-square = 11.2, df = 4, p < 0.04). The high psychosocial risk group was more likely to have died/deteriorated and less likely to have improved than the low psychosocial risk group.


CONCLUSIONS
Regardless of disease severity, socially isolated HTx candidates who are also depressed may be at increased risk for clinical deterioration and mortality, indicating a need for psychosocial intervention.
Spaderna
Heike
H
Psychological Institute, Johannes Gutenberg University, Mainz, Germany. spaderna@uni-mainz.de
Mendell
Nancy Role
NR
Zahn
Daniela
D
Wang
Yifan
Y
Kahn
Judith
J
Smits
Jacqueline M A
JM
Weidner
Gerdi
G
D000328:Adult; D000368:Aged; D001317:Austria; D003863:Depression / Q000523:psychology*; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000401:mortality / Q000523:psychology* / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011584:Psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D012934:Social Isolation / Q000523:psychology*; D014850:Waiting Lists