# Psychosocial Risk and Recurrent Hospitalizations in Women and Men Following LVAD Implantation: A Multi-State Analysis of the INTERMACS Registry

## TL;DR

Women with psychosocial risks before LVAD implantation face higher rehospitalization risks than men, highlighting the need for early intervention.

## Contribution

The study reveals that preimplant psychosocial risk independently increases rehospitalization hazards, especially in women.

## Key findings

- Women with psychosocial risk had 2.2 hospitalizations in one year, compared to 1.8 without such risk.
- Women with psychosocial risk spent 20 days in the hospital, compared to 16 days without such risk.
- The interaction of female sex and psychosocial risk increased rehospitalization hazards (HRadj 1.11).

## Abstract

Background: Women experience higher rates of adverse events and first rehospitalization after left ventricular assist device (LVAD) implantation compared with men. This study investigated the role of sex and preimplant psychosocial risk in recurrent hospitalizations. Methods: Data from 20,123 INTERMACS patients (21.3% women) were analyzed. Cumulative transition rates (e.g., home to hospitalization) were estimated and Andersen–Gill models, adjusted for covariates, examined the association between sex, preimplant psychosocial risk, and cumulative transition hazards for rehospitalization. State occupation probabilities, the mean number of hospitalizations, and the cumulative average length of hospital stay were calculated and stratified by sex and psychosocial risk. Results: Psychosocial risk preimplant was more prevalent in men than in women (21.4% vs. 17.5%, p < 0.001). The interaction of female sex and psychosocial risk increased rehospitalization hazards, independently of covariates [HRadj 1.11, 95% CI (1.01–1.22), p = 0.036]. One-year postimplant, women with vs. without psychosocial risk had 2.2 vs. 1.8 hospitalizations, while men experienced 1.8 vs. 1.7 hospitalizations, respectively. Women with vs. without psychosocial risk spent 20 vs.16 days hospitalized, and men 15 vs. 14 days (all p < 0.001). Conclusions: Preimplant psychosocial risk independently contributed to recurrent hospitalizations post-LVAD, particularly affecting women. The early identification and management of these factors may reduce rehospitalizations and improve clinical outcomes.