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Mental Health and Substance Use Disorders in Transplant Waitlist, VAD, and Heart Transplant Patients: A TriNetX Database Analysis

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24 April 2024

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24 April 2024

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Abstract
Background/ObjectivesMental health and substance use disorders (MHD, SUD) affect cardiac allograft and VAD recipients and impact their quality of life and compliance. Limited research on MHDs and SUDs in transplant and MCS candidates and recipients. This study compares the incidence of MHDs and SUDs in transplant list, VAD, and post-transplant patients with that in heart failure patients. MethodsStudy cohorts were derived from the TriNetX using ICD-10 codes. Differences in incidence were examined using the log-rank test. Adults with mental health disorders before the window of time were excluded. Propensity score matching was performed using TriNetX to balance demographic and medical comorbidities. Statistical significance was set at p<0.05. All comparisons were made between propensity-matched cohorts. ResultsTransplant waitlist patients showed a statistically significant increase in the incidence of anxiety, panic disorder, adjustment disorder, depression, mood disorder, alcohol use disorder, and eating disorder. Post-transplant patients showed a statistically significant increase in the incidence of depression and opioid use compared to the heart failure population. VAD patients showed a statistically significant increase in the incidence of depression and a statistically significant decrease in panic disorder and anxiety. ConclusionsThe results pave the pathway for further investigations on prevention and coping strategies because deterioration of mental health will significantly impact compliance with medications as well as patient survival and quality of life. The use of opioids for pain management in the early postoperative period should be further investigated to assess its impact on long-term substance use and addiction. .
Keywords: 
substance use; cardiac transplant; VAD; mental health
Subject: 
Medicine and Pharmacology  -   Cardiac and Cardiovascular Systems

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.

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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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