1. Introduction
Patients with advanced heart failure may wait years on the cardiac transplant list before undergoing heart transplantation. Others may be candidates for ventricular assistance devices (VADs) as a bridge to transplant or as a destination therapy. The uncertainty, fear, and medical challenges of these experiences may have a significant impact on patients’ mental health. Depression affects up to 60% of solid-organ recipients and most studies suggest depression is an independent risk factor for increased morbidity and mortality after transplant [
1,
2,
3]. Poor mental health has been shown to decrease treatment compliance and increase hospitalizations/ infectious complications in post-transplant patients [
4,
5]. Use of immunosuppressive drugs, especially corticosteroids and calcineurin inhibitors, continued medical issues, and health anxiety likely contribute to deterioration in mental and physical health [
1].
After cardiac transplantation or VAD implantation, concerns such as diet, adjustment, lifestyle, medication regimen, and follow-up care are closely monitored, especially in the months following surgery. However, psychiatric disorders may present during the pre-operative and anytime in the postoperative course, thus requiring lifelong attention. This emphasizes the need for multidisciplinary care coordination and support for heart failure patients while waiting, before and after surgical intervention. Rehabilitation should not only address physical wellbeing but also cognitive and psychological functioning which are needed to extend beyond the post-operative period.
Elevated rates of depression, anxiety, and decreased QOL have been identified in post-transplant patients and inconsistently in VAD patients [
6,
7,
8]. However, there is limited evidence as to the effect of other mental health disorders (MHDs) and SUDs. This study compares the incidence of a wide range of MHDs and SUDs in the transplant waitlist, VAD, and post-transplant patients with that of heart failure patients.
2. Materials and Methods
Data from TriNetX was used to derive study cohorts using ICD-10 codes shown in
Table 1. The incidence of MHDs and SUDs was compared in adult heart failure with the transplant waitlist, VAD, and cardiac transplant patients within 15 years of the index event. Index events that occurred up to 20 years ago were included. The index event was defined as the time the patient entered the cohort. This was set to the first diagnosis of heart failure for control patients and the date of transplant/VAD insertion or first registration on the cardiac transplant waitlist. Differences in incidence were examined using the log-rank test and hazard ratios. Patients with mental health disorders before the window of time were excluded. Patients between ages 0-100 were included. Propensity score matching was performed using TriNetX to balance demographic and medical comorbidities. Statistical significance was set at p ≤0.05.
TriNetX is a global health research network that compiles data from the electronic health records of many healthcare organizations. These include large academic medical institutions across the world. The data are stored on servers or through a virtual platform at participating institutions that are subsequently collected and aggregated. The data include demographic characteristics, diagnoses, medications, laboratory values, and procedures. This project included data from the Global Collaborative Network, 30 countries, and 104 healthcare organizations. The database includes insured and uninsured patients. This study is Health Insurance Portability and Accountability Act compliant and was exempt from IRB approval. For outcomes with <10 patients, TriNetX reports a value of 10 patients to protect patient privacy.
3. Results
3.1.1. Transplant Waitlist Patients
After propensity score matching, 29,900 patients were identified in each cohort. The mean ages at the index event were 49.3 +/- 21.5 heart failure and 64.6 +/- 18.7 transplant waitlist patients, respectively. The characteristics of this cohort are shown in
Table 2.
Transplant waitlist patients showed a statistically significant increase in the incidence of anxiety, panic disorder, adjustment disorder, depression, alcohol use disorder, and eating disorder. Survival analysis showed a statistically significant impact of anxiety, panic disorder, adjustment disorder, depression, mood disorder, nicotine dependence, opioid use, dementia, and eating disorders on the waitlist patients. Other parameters tested were not significant as shown in
Table 3.
3.1.2. Cardiac Transplant Patients
After propensity score matching, 4,855 patients were identified in each cohort. The only variable that differed significantly between the two groups was age, which was higher in heart failure patients as shown in
Table 4. The mean age at index was 68.9 +/- 16.7 for heart failure and 44.8 +/- 20.9 for transplant patients.
Post-transplant patients showed a statistically significant 1.5 to 2-fold increase in the incidence of adjustment disorder, depression, and opioid use compared to the heart failure population as noted in
Table 5. Survival analysis showed a statistically significant impact of a heart transplant on adjustment, mood, and opioid use disorders. Other parameters tested were not significant.
3.1.3. VAD Patients
10,659 patients were identified in each cohort after propensity score matching. The VAD cohort was older than the heart failure cohort (61.3 +/- 16.4 versus 34.1 +/- 20.3 years, respectively). Other baseline characteristics shown in
Table 6 were comparable between groups.
VAD patients showed a statistically significant increase in the incidence of depression and a statistically significant decrease in panic disorder and anxiety. No significant difference was noted in the incidence of somatoform, adjustment, mood, alcohol, eating, opioid disorders, PTSD, nicotine use, or self-harm. Survival analysis (13.6 years) showed a statistically significant impact of anxiety, panic disorder, PTSD, adjustment, depression, eating disorder, self-harm, opioid/alcohol use, and nicotine dependence as noted in
Table 7. Interestingly, opioid use in this population seems to confer a survival benefit with a hazard ratio of 0.74. A marginal but significant survival benefit was also noted with nicotine dependence. Both of these factors showed a nonsignificant decrease in incidence in the VAD population.
4. Discussion
The majority of studies about mental health and transplant/VAD patients to date focus on depressive and anxiety symptoms in cardiac transplant patients. We have attempted to perform a comprehensive analysis of MHDs and SUDs in three subgroups of heart failure patients using the largest patient cohort size to date.
Transplant list patients:
The waitlist period can last days to years. Absolute contraindications are a history of medical noncompliance and poor social support [
9]. Some studies suggest that psychiatric conditions may negatively affect transplant outcomes through poor adherence, self-injurious behaviors, drug interactions, and poor social support on the whole [
10].
Our results found that cardiac transplant wait list patients showed a statistically significant increase in the incidence of six psychiatric disorders ( anxiety, depression, panic, adjustment, alcohol use, and eating disorders; whereas in the post-transplant patients, significant increases in incidence were noted only in adjustment disorder and depression. In the VAD population significant increase in incidence was only noted in depression while anxiety and panic disorder were significantly decreased.
The trends noted in this study may be because the waitlist period is critical in maintaining eligibility for transplants and a time of uncertainty, fear, and stress. Early diagnosis, treatment, and improved access to resources for patients on the transplant waitlist are critical in improving survival and candidacy for transplant patients. This also highlights inequity between those who may have better social support and increased access to care and resources which need further investigation.
Literature regarding posttransplant outcomes of patients with psychiatric disorders is inconsistent [
11]. Studies cite a history of suicide/self-harm, depressive episodes, and poor medical adherence as the greatest factors impacting posttransplant survival time [
12,
13]. However, a comprehensive review contradicted these findings, suggesting that there is no clear association between prior psychiatric illness and morbidity and mortality and that patients with psychiatric conditions can have good outcomes after transplant [
11,
14]. Candidacy for transplant should be made through consideration of individual risk factors, not the presence of psychiatric conditions to avoid stigmatization of this patient population.
Cardiac transplant patients:
Our results found that transplant patients had a significant increase in the incidence of depression and opioid use disorder compared to heart failure patients. This supports existing literature suggesting that transplant increases the risk of depression, often due to difficulty in coping with a lifestyle change and complications [
15,
16,
17]. Interestingly, it is thought that rates of anxiety and depression are lower in patients receiving heart transplants compared to other cardiac surgeries, including valve replacement [
18].
Studies have found cardiac transplant patients are at increased risk (3-10%) of developing opioid use disorder. Severe pain during the recovery period may increase the risk of long-term dependence on opioids [
19]. Decreasing the dose and duration of opioids prescribed at discharge may decrease the risk of long-term opioid use and dependence.
VAD patients:
Our results found that VAD patients showed a statistically increased incidence of depression and statistically significant decrease in panic disorder and anxiety following VAD implantation. Some evidence shows an initial improvement in depression and anxiety after implantation, however, patient-reported outcomes remained lower than those of transplant patients [
7,
20]. Our study looked at the longitudinal development of these disorders on a scale of over ten years, whereas these studies looked at weeks-month long periods. Further investigation into the timing and onset of anxiety and depression is warranted.
VADs increase the risk of PTSD or panic disorder, despite the possibility of acute VAD dysfunction or mechanical failure [
7]. Similarly, our results found a statistically significant decrease in the incidence of PTSD and anxiety following VAD insertion compared to heart failure patients. Existing literature is primarily focused on anxiety, depression, and PTSD only.
Studies have found that depression and anxiety increase prior to VAD implantation, decline again after surgery, and resurface with complications and difficulty with adjustment [
7,
8]. While services are aimed at all phases, counseling, and psychiatric services are generally concentrated around surgical intervention [
6,
21,
22]. Years after the transplant, the patient may still struggle to cope and have recurrent medical complications. Patients with depression have been found to have elevated rates of stroke and sepsis [
2]. Resources are most concentrated around the pre- and post-operative period. MHDs and SUDs are known to impact treatment compliance as well as compliance with lifestyle interventions, which is an important factor in predicting survival. Screening, counseling, and pharmacologic treatment should be offered when necessary.
This study was limited by its retrospective nature. Transplant candidates and VAD/transplant recipients may have more frequent interactions with the healthcare system and may be more likely to be diagnosed with a MHD or SUD than patients with heart failure. Some misidentification is possible with use of a large, national database. Because the database was intended for billing purposes, it lacks granularity and may be missing data, which could contribute to underreporting of MHDs/SUDs. We were also unable to account for comorbid SUDs and MHDs. Further studies should assess the time to onset of mental health disorders and trends in correlation with treatment advances. There is also a need to determine the optimal management of patients with pre-existing MHDs in addition to those who develop disorders.
5. Conclusions
These results lay the groundwork for further studies to investigate current prevention and strategies in place for transplant candidates as well as transplant and VAD patients. Increased rates of MHDs and SUDs are likely multifactorial. Early diagnosis, treatment, and improved access to resources for VAD, transplant candidates, and recipients may improve outcomes. Incorporation of longitudinal psychiatric care may improve patient quality of life and survival.
Author Contributions
Conceptualization, N.N., D.D and B.M.; methodology, C.G, D.D.; software, C.G.; validation, N.N., D.D.; formal analysis, C.G.; Investigation, N.N., D.D and C.G.; resources, N.N.; data curation, N.N.; writing—original draft preparation, C.G; writing—review and editing, N.N; visualization, N.N.; supervision, N.N; project administration, N.N.D.D.; funding acquisition, None for this project. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Not applicable as a public database was used.
Informed Consent Statement
Not applicable as a public database was used.
Data Availability Statement
Data will be made available on request.
Conflicts of Interest
None of the authors have any conflicts of interest concerning this work/project.
References
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Table 1.
Diagnosis ICD codes used.
Table 1.
Diagnosis ICD codes used.
Diagnosis |
ICD Codes |
Heart failure (LV failure) |
I50.1 |
VAD |
Z95.811 |
Heart transplant list |
Z94.1 |
Heart transplant recipient |
33945 |
Depression |
F32, F33 |
Mood disorder |
F39 |
Anxiety |
F41.1 |
Panic disorder |
F41.0 |
PTSD |
F43.1 |
Adjustment disorder |
F43.2 |
Eating disorders |
F50 |
Somatoform disorders |
F50 |
ADHD |
F90 |
Opioid-use disorders |
F11 |
Alcohol-use disorders |
F10 |
Nicotine dependence |
F17 |
Dementia |
F03 |
Suicidal ideation or self-harm |
R45.851, R45.88, T14.91, T50.902, X71-X83 |
Table 2.
Propensity score matching for transplant waitlist versus heart failure patients.
Table 2.
Propensity score matching for transplant waitlist versus heart failure patients.
Characteristic |
Before Matching |
After Matching |
|
Heart failure patients |
Transplant list patients |
Standard Difference |
Heart failure patients |
Transplant list patients |
Standard Difference |
Age at index, years |
49.3 +/- 21.5 |
69.1 +/- 16.5 |
1.029 |
49.4 +/- 21.5 |
64.6 +/- 18.7 |
0.755 |
Male |
163210 (57.6%) |
20259 (67.7%) |
0.208 |
20361 (68.1%) |
20217 (67.6%) |
0.01 |
Race |
|
|
|
|
|
|
White |
148374 (52.4%) |
17628 (58.9%) |
0.131 |
17576 (58.8%) |
17607 (58.9%) |
0.002 |
American Indian or Alaska Native |
498 (0.2%) |
95 (0.3%) |
0.029 |
99 (0.3%) |
95 (0.3%) |
0.002 |
Pacific Islander |
1273 (0.4%) |
80 (0.3%) |
0.31 |
90 (0.3%) |
80 (0.35) |
0.006 |
Black or African American |
23891 (8.4%) |
5130 (17.1%) |
0.263 |
5291 (17.7%) |
5105 (17.1%) |
0.016 |
Asian |
7954 (2.8%) |
658 (2.2%) |
0.39 |
627 (2.1%) |
658 (2.2%) |
0.007 |
Essential hypertension |
130274 (46.0%) |
10664 (35.5%) |
0.213 |
10906 (36.5%) |
10664 (35.7%) |
0.017 |
Neoplasms |
61898 (21.9%) |
5867 (19.6%) |
0.056 |
5808 (19.4%) |
5860 (19.6%) |
0.004 |
Diabetes mellitus |
72647 (25.7%) |
7237 (24.2%) |
0.034 |
7264 (24.3%) |
7224 (24.2%) |
0.003 |
Obesity and overweight |
45565 (16.1%) |
4255 (14.2%) |
0.052 |
4212 (14.1%) |
4249 (14.2%) |
0.004 |
Psychosocial stressors |
13436 (4.7%) |
899 (3.0%) |
0.09 |
856 (2.9%) |
899 (3.05) |
0.009 |
Chronic lower respiratory diseases |
60391 (21.3%) |
4738 (15.8%) |
0.142 |
4741 (15.9%) |
4735 (15.8%) |
0.001 |
Epilepsy or seizures |
6007 (2.1%) |
689 (2.3%) |
0.012 |
661 (2.0%) |
686 (2.3%) |
0.017 |
Cerebral infarction |
19796 (7.0%) |
1978 (6.6%) |
0.015 |
1845 (6.2%) |
1974 (6.6%) |
0.018 |
Ischemic heart diseases |
109963 (38.8%) |
9370 (31.3%) |
0.159 |
9293 (31.1.%) |
9368 (31.3%) |
0.005 |
Heart failure |
96068 (33.9%) |
13166 (44.0%) |
0.207 |
13054 (43.7%) |
13120 (43.9%) |
0.004 |
Atrial fibrillation and flutter |
69909 (24.7%) |
6655 (22.2%) |
0.058 |
6491 (21.7%) |
6638 (22.2%) |
0.012 |
Cardiomyopathy |
41677 (14.7%) |
10244 (34.2%) |
0.466 |
10140 (33.9%) |
10198 (34.1%) |
0.004 |
Fibrosis and cirrhosis of live |
5393 (1.9%) |
1189 (4.0%) |
0.123 |
1052 (3.5%) |
1173 (3.9%) |
0.021 |
Chronic kidney disease and acute kidney failure |
74403 (26.3%) |
9736 (32.5%) |
0.137 |
9711 (32.5%) |
9693 (32.4%) |
0.001 |
Number of patients |
283188 |
29946 |
|
29900 |
29900 |
|
Table 3.
Incidence of MHDs/ SUDs in transplant waitlist patients versus heart failure patients.
Table 3.
Incidence of MHDs/ SUDs in transplant waitlist patients versus heart failure patients.
|
Incidence |
|
Survival Analysis |
Disorder |
Incidence in Cardiac Transplant wait, list patients, |
Incidence in Control (Heart failure) |
p-value for incidence analysis |
Hazard Ratio |
Hazard ratio p-value |
|
Expressed as the total number in propensity-matched cohort |
Expressed as the total number in propensity-matched cohort |
|
|
|
Somatoform Disorder |
261/29773 |
144/29759 |
0.86 |
1.57 |
0.4 |
Anxiety |
1289/28969 |
505/29254 |
0.001* |
1.771 |
0.003* |
Panic Disorder |
552/29460 |
260/29557 |
0.042* |
1.486 |
0.032* |
PTSD |
496/29344 |
205/29645 |
0.117 |
1.686 |
0.079 |
Adjustment Disorder |
1495/28298 |
638/29269 |
0.00* |
1.742 |
0.00* |
Depression |
4293/25149 |
2194/25819 |
0.00* |
1.5 |
0.00* |
Mood Disorder |
600/29587 |
281/29598 |
0.126 |
1.463 |
0.004* |
Nicotine Dependence |
1459/27603 |
1292/24832 |
0.913 |
0.706 |
0.012* |
Alcohol Use Disorder |
792/28615 |
785/27658 |
0.015* |
0.685 |
0.466 |
Opioid Use |
495/29621 |
276/29460 |
0.146 |
1.261 |
0.00* |
Dementia |
492/29749 |
895/29118 |
0.126 |
0.261 |
0.00* |
Eating Disorder |
264/29734 |
144/29783 |
0.011* |
1.279 |
0.025* |
Self-Harm |
688/29463 |
574/29302 |
0.251 |
0.811 |
0.487 |
*p<0.05 |
|
|
|
|
|
Table 4.
Propensity score matching for cardiac transplant versus heart failure patients.
Table 4.
Propensity score matching for cardiac transplant versus heart failure patients.
Characteristic |
Before Matching |
After Matching |
|
Heart failure patients |
Transplant patients |
Standard Difference |
Heart failure patients |
Transplant patients |
Standard Difference |
Age at index, years |
68.9 +/- 16.7 |
44.8 +/- 20.9 |
1.274 |
62.9 +/- 17.3 |
44.8 +/- 20.9 |
0.944 |
Male |
164631 (57.7%) |
3344 (68.7%) |
0.229 |
3360 (69.2%) |
3333 (68.7%) |
0.012 |
Race |
|
|
|
|
|
|
White |
149310 (52.4%) |
3081 (63.3%) |
0.223 |
3139 (64.7%) |
3071 (63.3%) |
0.029 |
American Indian or Alaska Native |
507 (.2%) |
10 (.2%) |
0.006 |
11 (.2%) |
10 (.2%) |
0.004 |
Pacific Islander |
1281 (.4%) |
10 (.2%) |
0.043 |
10 (.2%) |
10 (.2%) |
<.001 |
Black or African American |
24349 (8.5%) |
1054 (21.7%) |
0.373 |
991 (20.4%) |
1051 (21.6%) |
0.03 |
Asian |
7967 (2.8%) |
84 (1.7%) |
0.072 |
68 (1.4%) |
84 (1.7%) |
0.027 |
Essential hypertension |
131365 (46.1%) |
2937 (60.3%) |
0.289 |
2992 (61.6%) |
2937 (60.5%) |
0.023 |
Neoplasms |
62477 (21.9%) |
1580 (32.5%) |
0.239 |
1571 (32.4%) |
1577 (32.5%) |
0.003 |
Diabetes mellitus |
73369 (25.7%) |
2106 (43.3%) |
0.376 |
2099 (43.2%) |
2098 (43.2%) |
<001 |
Obesity and overweight |
46002 (16.1%) |
1509 (31.0%) |
0.356 |
1536 (31.6%) |
1506 (31.0%) |
0.013 |
Psychosocial stressors |
13542 (4.7%) |
391 (8.0%) |
0.135 |
348 (7.2%) |
391 (8.1%) |
0.033 |
Chronic lower respiratory diseases |
60902 (21.4%) |
1339 (27.5%) |
0.144 |
1333 (27.5%) |
1338 (27.6%) |
0.002 |
Epilepsy or seizures |
6062 (2.1%) |
208 (4.3%) |
0.122 |
162 (3.3%) |
206 (4.2%) |
0.047 |
Cerebral infarction |
20026 (7.0%) |
853 (17.5%) |
0.324 |
774 (15.9%) |
848 (17.5%) |
0.041 |
Ischemic heart diseases |
111021 (38.9%) |
3002 (61.7%) |
0.467 |
3012 (62.0%) |
2999 (61.8%) |
0.006 |
Heart failure |
97555 (34.2%) |
4512 (92.7%) |
1.529 |
4483 (92.3%) |
4500 (92.7%) |
0.013 |
Atrial fibrillation and flutter |
70600 (24.8%) |
2545 (52.3%) |
0.59 |
2475 (51.0%) |
2535 (52.2%) |
0.025 |
Cardiomyopathy |
42890 (15.0%) |
4089 (84.0%) |
1.905 |
4115 (84.8%) |
4077 (84.0%) |
0.022 |
Fibrosis and cirrhosis of live |
5488 (1.9%) |
383 (7.9%) |
0.278 |
357 (7.4%) |
372 (7.7%) |
0.012 |
Chronic kidney disease and acute kidney failure |
75401 (26.4%) |
3411 (70.1%) |
0.971 |
3389 (69.8%) |
3399 (70.0%) |
0.004 |
Number of patients |
285200 |
4867 |
|
4855 |
4855 |
|
Table 5.
Incidence of MHDs/ SUDs in cardiac transplant versus heart failure patients.
Table 5.
Incidence of MHDs/ SUDs in cardiac transplant versus heart failure patients.
|
Incidence |
|
Survival analysis |
Disorder |
Incidence in Post heart transplant |
Incidence in Control (Heart failure) |
P-value for incidence |
Hazard Ratio |
Hazard p-value |
|
Expressed as the total number in the propensity-matched cohort |
Expressed as the total number in the propensity-matched cohort |
Somatoform Disorder |
66/4822 |
32/4810 |
0.425 |
1.644 |
0.845 |
Anxiety |
270/4531 |
138/4658 |
0.391 |
1.603 |
0.059 |
Panic Disorder |
109/4656 |
63/4757 |
0.29 |
1.394 |
0.067 |
PTSD |
116/4612 |
72/4781 |
0.346 |
1.307 |
0.737 |
Adjustment Disorder |
292/4108 |
180/4633 |
0.046 |
1.527 |
0.00*
|
Depression |
645/3416 |
468/3642 |
0* |
1.217 |
0.094 |
Mood Disorder |
148/4736 |
95/4772 |
0.261 |
3.191 |
0.00* |
Nicotine Dependence |
255/4233 |
258/3708 |
0.168 |
0.671 |
0.281 |
Alcohol Use Disorder |
134/4456 |
184/4206 |
0.64 |
0.554 |
0.072 |
Opioid Use |
144/4769 |
67/4726 |
0.038* |
1.791 |
0.009* |
Dementia |
48/4834 |
168/4693 |
0.993 |
0.215 |
0.878 |
Eating Disorder |
65/4782 |
42/4810 |
0.08 |
1.234 |
0.462 |
Self-Harm |
134/4707 |
174/4675 |
0.123 |
0.605 |
0.786 |
*p<0.05 |
|
|
|
|
|
Table 6.
Propensity score matching for VAD versus heart failure patients.
Table 6.
Propensity score matching for VAD versus heart failure patients.
Characteristic |
Before Matching |
After Matching |
|
Heart failure patients |
VAD patients |
Standard Difference |
Heart failure patients |
VAD patients |
Standard Difference |
Age at index, years |
34.1 +/- 20.3 |
61.3 +/- 16.4 |
1.469 |
38.1 +/- 22.2 |
58.2 +/- 17.7 |
1.004 |
Male |
18737 (34.6%) |
17882 (66.6%) |
0.675 |
6700 (62.9%) |
6435 (60.4%) |
0.051 |
Race |
|
|
|
|
|
|
White |
26699 (50.3%) |
17195 (64.0%) |
0.28 |
6320 (59.3%) |
6565 (61.6%) |
0.047 |
American Indian or Alaska Native |
94 (0.2%) |
121 (0.5%) |
0.049 |
53 (0.5%) |
48 (0.5%) |
0.007 |
Pacific Islander |
52 (0.1%) |
63 (0.2%) |
0.34 |
22 (0.2%) |
22 (0.2%) |
<0.001 |
Black or African American |
9854 (18.6%) |
5629 (21%) |
0.06 |
2174 (20.4%) |
2096 (19.6%) |
0.018 |
Asian |
2205 (4.2%) |
430 (1.6%) |
0.153 |
238 (2.2%) |
225 (2.1%) |
0.008 |
Essential hypertension |
10839 (20.4%) |
14295 (53.2%) |
0.723 |
3522 (33.0%) |
3163 (29.7%) |
0.073 |
Neoplasms |
8744 (16.5%) |
7244 (27%) |
0.257 |
1927 (18.1%) |
1811 (17.0%) |
0.029 |
Diabetes mellitus |
5799 (10.9%) |
9246 (34.4%) |
0.585 |
1892 (17.8%) |
1764 (16.5%) |
0.032 |
Obesity and overweight |
8238 (15.3%) |
7305 (27.2%) |
0.293 |
1515 (14.2%) |
1536 (14.4%) |
0.006 |
Psychosocial stressors |
2631 (5.0%) |
1983 (7.4%) |
0.101 |
468 (4.4%) |
449 (4.2%) |
0.009 |
Chronic lower respiratory diseases |
9088 (17.1%) |
6932 (25.8%) |
0.213 |
1615 (15.2%) |
1595 (15.0%) |
0.005 |
Epilepsy or seizures |
1722 (3.2%) |
803 (3.0%) |
0.015 |
322 (3.0%) |
275 (2.6%) |
0.027 |
Cerebral infarction |
1209 (2.3%) |
3359 (12.5%) |
0.399 |
717 (6.7%) |
649 (6.1%) |
0.026 |
Ischemic heart diseases |
2482 (4.7%) |
14479 (53.9%) |
1.286 |
2028 (19.0%) |
1899 (17.8%) |
0.031 |
Heart failure |
1537 (2.9%) |
15385 (57.3%) |
1.472 |
1460 (13.7%) |
1551 (14.6%) |
0.025 |
Atrial fibrillation and flutter |
1005 (1.9%) |
9932 (36.2%) |
0.993 |
915 (8.6%) |
1027 (9.6%) |
0.037 |
Cardiomyopathy |
774 (1.5%) |
9733 (36.2%) |
0.993 |
722 (6.8%) |
869 (8.2%) |
0.052 |
Fibrosis and cirrhosis of live |
606 (1.1%) |
929 (3.5%) |
0.155 |
219 (2.1%) |
207 (1.9%) |
0.008 |
Chronic kidney disease and acute kidney failure |
2924 (5.5%) |
10741 (40.0%) |
0.902 |
1609 (15.1%) |
1477 (13.9%) |
0.035 |
Number of patients |
53119 |
26866 |
|
10659 |
10659 |
|
Table 7.
Incidence of MHDs/ SUDs in VAD versus heart failure patients.
Table 7.
Incidence of MHDs/ SUDs in VAD versus heart failure patients.
|
Incidence |
|
Survival Analysis |
Disorder |
Incidence in VAD patients |
Incidence in Control (Heart failure) |
p-value for Incidence analysis |
Hazard Ratio |
Hazard ratio p-value |
|
Expressed as the total number in the propensity-matched cohort |
Expressed as the total number in the propensity-matched cohort |
|
|
|
Somatoform Disorder |
62/10596 |
64/10568 |
0.722 |
1.6 |
0.642 |
Anxiety |
265/10341 |
345/10120 |
0.011* |
0.9 |
0.044* |
Panic Disorder |
117/10453 |
127/10453 |
0.014* |
1.1 |
0.013* |
PTSD |
125/10456 |
140/10448 |
0.056 |
1.1 |
0.02* |
Adjustment Disorder |
429/10209 |
226/10360 |
0.087 |
2.3 |
0.00* |
Depression |
1035 /8849 |
813/8750 |
0.003* |
1.6 |
0.00* |
Mood Disorder |
174/10509 |
95/10496 |
0.286 |
2.1 |
0.82 |
Nicotine Dependence |
452/8868 |
540/8226 |
0.212 |
0.9 |
0.00* |
Alcohol Use Disorder |
300/10004 |
239/9818 |
0.873 |
1.4 |
0.00* |
Opioid Use |
134/10466 |
206/10258 |
0.563 |
0.74 |
0.001* |
Dementia |
166/10500 |
71/10584 |
0.598 |
2.75 |
0.138 |
Eating Disorder |
63/10592 |
43/10569 |
0.779 |
1.62 |
0.031* |
Self-Harm |
207/10404 |
145/10405 |
0.057 |
1.7 |
0.03* |
*p<0.05 |
|
|
|
|
|
|
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