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

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, mean number of hospitalizations, and 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< .001). The interaction of female sex and psychosocial risk increased rehospitalization hazards, independent of covariates [HRadj 1.11, 95% CI (1.01-1.22), p=.036]. One-year postimplant, women with vs. without psychosocial risk had 2.2 vs. 1.8 hospitalizations, while men experience 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 ps< .001). Conclusions: Preimplant psychosocial risk independently contributed to recurrent hospitalizations post-LVAD, particularly affecting women. Early identification and management of these factors may reduce rehospitalizations and improve clinical outcomes.