Psychiatric Disorders and Associated Factors in Left Ventricular Assist Device Implantation and Heart Transplant Candidates

Introduction: End-stage heart failure (ESHF) remains a significant challenge despite optimal treatment, with heart transplantation (HTx) being the gold standard of care. Mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs) are increasingly used for temporary or permanent treatment. Psychiatric comorbidities are common in patients with ESHF and may affect treatment outcomes, but the relationship between sociodemographic, clinical, and psychiatric characteristics remains unclear.

Methods: A medical record based, descriptive cross-sectional study was conducted on 94 ESHF patients scheduled for HTx or LVAD therapy. Sociodemographic, clinical, and psychiatric data, including psychiatric diagnoses and systemic inflammatory markers, were collected from medical records. Univariate analyses compared patients with (PD) and without psychiatric disorders (No-PD).

Results: Of the participants, 37% had active psychopathology, with major depressive disorder (MDD) and generalized anxiety disorder (GAD) being prevalent. Approximately half of those diagnosed received their first psychiatric diagnosis at the time of assessment. Sociodemographic factors did not differ significantly between the PD and No-PD groups. While no significant difference was observed in ejection fraction (%) and inflammatory markers such as C-reactive protein (CRP), lymphocyte count was higher in the PD group.

Conclusions: Preoperative psychiatric assessment is crucial to identify psychiatric comorbidities in ESHF patients undergoing HTx or LVAD therapy. Despite limitations, this study sheds light on previously unexplored aspects, such as the relationship between ejection fraction and psychiatric comorbidities and the relationship between depressive symptoms and inflammatory markers obtained from complete blood count. Furthermore, the fact that almost half of the patients with psychiatric comorbidity were first diagnosed during the pre-treatment psychiatric assessment underlines the importance of pre-LVAD and pre-HTX psychiatric evaluation.