Association Between the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation and Adjustment Disorder in Japanese Patients Using Ventricular Assist Devices as a Bridge to Heart Transplantation

Objective: Ventricular assist device (VAD) serves as either a bridge to transplantation (BTT) or destination therapy (DT) for end-stage heart failure. In Japan, the extended wait time for heart transplants can make VAD usage for BTT comparable in duration to DT in other countries. Previous studies suggest that while DT patients experience improved quality of life post-VAD implantation, BTT patients often see a decline after two years. This study aims to explore the association between scores of the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J), adverse medical events (AMEs) and psychiatric disorders, particularly adjustment disorder (AD), in Japanese BTT patients.

Methods: A retrospective analysis was conducted on 24 Japanese patients who underwent VAD implantation for BTT between August 2014 and December 2019. The SIPAT-J, which evaluates the patient's readiness level, social support system, psychological stability and psychopathology, and lifestyle and effects of substance use, was applied to medical records. Psychiatric diagnoses were reviewed to identify AMEs, AD and other conditions. Patients were grouped by AMEs and AD status, and SIPAT-J scores were dichotomized at the median to examine potential associations. Statistical analysis was performed using Fisher's Exact test.

Results: There were no significant associations found between SIPAT-J scores and the development of AD or AMEs, likely due to the small sample size and varied observation periods, and differences in timing between diagnosis, evaluation, and VAD implantation. However, more than half of the patients developed psychiatric symptoms after VAD implantation, with delirium and insomnia being the most common. Identified stressors for AD included deteriorating family relationships, difficulty accepting heart disease, and future uncertainty. AMEs, which have been linked to AD onset in previous research, were also present in several cases.

Discussion: This study is the first to examine the relationship between any version of SIPAT and psychiatric outcomes in BTT patients. The results suggest that while SIPAT-J captures important psychosocial factors, additional factors related to VAD-induced lifestyle changes and family dynamics may be crucial for predicting AD risk. Therefore, future research should consider a more detailed psychosocial evaluation to capture patient expectations about post-VAD life. Although preliminary, this study underscores the need for comprehensive psychosocial screening in BTT patients to facilitate early intervention and support for those at risk of AD.