Marital status and survival in left ventricular assist device patient populations

Social support is an important aspect of a patient’s care. Although left ventricular assist devices (LVADs) have been shown to improve survival in advanced heart failure patients and in bridging them to heart transplantation, there are also associated risks with LVAD therapy. For example, patients can experience increased risk of infection, thrombus, and bleeding. Avoiding these complications requires attentive and persistent care. Before an LVAD is implanted, a primary caregiver and other social support should be identified to improve quality of care and length of survival. It has been shown that married patients undergoing heart surgery have a better chance of survival than those who are not married undergoing the same procedure. The purpose of this study was to explore the survival of married and unmarried patients after an LVAD implant and to study the effect marital status has in survival for LVAD patients. After obtaining Investigational Review Board approval, patient data were collected retrospectively from 2004 to April 2014, with 133 continuous-flow LVAD patients included. Data were retrieved from the Artificial Heart Program database at Intermountain Medical Center. Each patient was categorized into 1 of 6 marital statuses, namely: married, divorced, single, widowed, significant other, and separated (indicates a relationship in which the patient is still legally married but is neither living with nor using the spouse as the primary caregiver). Length of support, transplant status, death while on support, and primary caregiver were recorded and used for survival analysis. A Kaplan-Meier survival curve was generated for married and significant other vs unmarried and separated statuses. A log-rank test was used to determine significance. The study included 133 patients; of these, 104 were married or in a relationship with a significant other and 29 were unmarried or separated. Average age was 61 12 years for the married patients and 53 17 years for the unmarried or separated patients. Each group was similar in makeup, with 86% men in the unmarried or separated group and 81% men in the married group. In addition, each group had a median Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score of 3. Thirty patients were supported by the HeartWare HVAD (HeartWare International Inc, Framingham, MA) and 103 by the HeartMate II LVAD (Thoratec Corp, Pleasanton, CA). Rates of transplant were similar in the married and unmarried or separated group, at 39% and 37%, respectively. The 2-year Kaplan-Meier survival for the married group was 75% but was only 50% for the unmarried or separated group. The log-rank test returned a p-value of 0.007 (significance defined at p r 0.05). Mean survival time was 2.12 years (95% confidence interval [CI], 0.80– 3.44) for the unmarried or separated group and 4.25 years (95% CI, 3.32–5.18) for the married and significant other group. To account for competing risks between transplant and death, a competing hazard risk analysis was performed to assess the effect of marriage on LVAD survival. The effect of marriage on death had an estimated 95% CI of 0.253 to