title: Ventricular assist devices: a review of psychosocial risk factors and their impact on outcomes.
abstract: BACKGROUND
  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? Answers to this question could contribute to the development of treatment-specific (contra) indications for patients under consideration for mechanical devices.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; Houston Biomedical Ethics Program, Methodist Hospital, Houston, Texas. Electronic address: crbruce@bcm.edu.
authors.forename: Courtenay R
authors.initials: CR
authors.lastname: Bruce
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
authors.forename: Estevan
authors.initials: E
authors.lastname: Delgado
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kostick
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Sherry
authors.initials: S
authors.lastname: Grogan
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College, New York, New York.
authors.forename: Guha
authors.initials: G
authors.lastname: Ashrith
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College, New York, New York.
authors.forename: Barry
authors.initials: B
authors.lastname: Trachtenberg
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College, New York, New York.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas; Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas; Weill Cornell Medical College, New York, New York.
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhimaraj
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Linda
authors.initials: L
authors.lastname: Pham
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Blumenthal-Barby
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011584:Psychology; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: LVAD; ambulation; depression; frailty; outcomes; self-care