title: Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study.
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.affiliation: Department of Psychology, Johannes Gutenberg-University, Mainz, Germany. spaderna@uni-mainz.de
authors.forename: Heike
authors.initials: H
authors.lastname: Spaderna
authors.forename: Gerdi
authors.initials: G
authors.lastname: Weidner
authors.forename: Karl-Christian
authors.initials: KC
authors.lastname: Koch
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Florian M
authors.initials: FM
authors.lastname: Wagner
authors.forename: Jacqueline M A
authors.initials: JM
authors.lastname: Smits
mesh_terms: D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology / Q000601:surgery*; D016027:Heart Transplantation / Q000523:psychology*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists