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Inglis SS, Rosenbaum AN. Professional Employment With Left Ventricular Assist Device Support: Does Working With an LVAD Allow It to Work Too? ASAIO J 2024; 70:356-357. [PMID: 38457524 DOI: 10.1097/mat.0000000000002187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Affiliation(s)
- Sara S Inglis
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Cramer CL, Marsh K, Krebs ED, Mehaffey JH, Beller JP, Chancellor WZ, Teman NR, Yarboro LT. Long term employment following heart transplantation in the United States. J Heart Lung Transplant 2023; 42:880-887. [PMID: 36669942 DOI: 10.1016/j.healun.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/28/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Employment is an important metric of post-transplant functional status and the quality of life yet remains poorly described after heart transplant. We sought to characterize the prevalence of employment following heart transplantation and identify patients at risk for post-transplant unemployment. METHODS Adults undergoing single-organ heart transplantation (2007-2016) were evaluated using the UNOS database. Univariable analysis was performed after stratifying by employment status at 1-year post-transplant. Fine-Gray competing risk regression was used for risk adjustment. Cox regression evaluated employment status at 1 year with mortality. RESULTS Of 10,132 heart transplant recipients who survived to 1 year and had follow-up, 22.0% were employed 1-year post-transplant. Employment rate of survivors increased to 32.9% by year 2. Employed individuals were more likely white (70.8% vs 60.4%, p < 0.01), male (79.6% vs 70.7% p < 0.01), held a job at listing/transplant (37.6% vs 7.6%, p < 0.01), and had private insurance (79.1% vs 49.5%, p < 0.01). Several characteristics were independently associated with employment including age, employment status at time of listing or transplant, race and ethnicity, gender, insurance status, education, and postoperative complications. Of 1,657 (14.0%) patients employed pretransplant, 58% were working at 1-year. Employment at 1year was independently associated with mortality with employed individuals having a 26% decreased risk of mortality. CONCLUSION Over 20% of heart transplant patients were employed at 1 year and over 30% at 2 years, while 58% of those working pretransplant had returned to work by 1-year. While the major predictor of post-transplant employment is preoperative employment status, our study highlights the impact of social determinants of health.
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Affiliation(s)
| | - Katherine Marsh
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Jared P Beller
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Leora T Yarboro
- University of Virginia Health System, Charlottesville, Virginia.
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Zhang D, Wang J, Tao Z, Shi Y, Wang H, Chang T, Jiang X, Li X. Factors influencing employment rates and states after liver transplantation in China: A multi-centre cross-sectional study. Nurs Open 2023; 10:2582-2592. [PMID: 36448338 PMCID: PMC10006614 DOI: 10.1002/nop2.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/06/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
AIM The aim of this study was to assess employment rates and states and the factors influencing liver transplant recipients in China. DESIGN A cross-sectional study. METHODS A total of 212 liver transplant recipients were included in this study. Questionnaires for general situation information and the Hospital Anxiety and Depression Scale, Perceived Social Support Scale and Chronic Disease Self-Efficacy Scale were used. RESULTS Among the liver transplantation, 212 recipients were included in the study, 125 (59%) were employed after liver transplantation compared with 148 (69.8%) who were employed before liver transplantation. Among the 125 recipients that returned to work, only 38.2% thought their employment states were good before liver transplantation, while 81.6% thought that their employment states were good after liver transplantation. Gender, age and employment status before transplantation, aetiology of liver disease, number of physical activities, per capita monthly income, comorbidity and depression were significantly associated with return to work. Self-efficacy, social support, liver function and nature of work were significantly associated with employment state.
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Affiliation(s)
- Dan Zhang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jing Wang
- Nursing Department, Tianjin First Central Hospital, Tianjin, China
| | - Zijun Tao
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Shi
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Huili Wang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tiantian Chang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoyu Jiang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofei Li
- Transplantation and Hepatobiliary Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
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Mols RE, Løgstrup BB, Bakos I, Horváth-Puhó E, Christensen B, Witt CT, Schmidt M, Gustafsson F, Eiskjær H. Individual-Level Socioeconomic Position and Long-Term Prognosis in Danish Heart-Transplant Recipients. Transpl Int 2023; 36:10976. [PMID: 37035105 PMCID: PMC10073462 DOI: 10.3389/ti.2023.10976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023]
Abstract
Socioeconomic deprivation can limit access to healthcare. Important gaps persist in the understanding of how individual indicators of socioeconomic disadvantage may affect clinical outcomes after heart transplantation. We sought to examine the impact of individual-level socioeconomic position (SEP) on prognosis of heart-transplant recipients. A population-based study including all Danish first-time heart-transplant recipients (n = 649) was conducted. Data were linked across complete national health registers. Associations were evaluated between SEP and all-cause mortality and first-time major adverse cardiovascular event (MACE) during follow-up periods. The half-time survival was 15.6 years (20-year period). In total, 330 (51%) of recipients experienced a first-time cardiovascular event and the most frequent was graft failure (42%). Both acute myocardial infarction and cardiac arrest occurred in ≤5 of recipients. Low educational level was associated with increased all-cause mortality 10-20 years post-transplant (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.19-3.19). During 1-10 years post-transplant, low educational level (adjusted HR 1.66, 95% CI 1.14-2.43) and low income (adjusted HR 1.81, 95% CI 1.02-3.22) were associated with a first-time MACE. In a country with free access to multidisciplinary team management, low levels of education and income were associated with a poorer prognosis after heart transplantation.
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Affiliation(s)
- Rikke E. Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Brian B. Løgstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Bo Christensen
- Department of Public Health, Research Unit for General Medicine, Aarhus University, Aarhus, Denmark
| | | | - Morten Schmidt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Cardiology, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Dean M, Zoni CR, Copeland LA, Pickett C, Sudhakar CBS, Ravi Y. Retrospective analysis of the impact of pre-transplant implantable cardioverter-defibrillator status on long-term prognosis in heart transplant patients. Clin Transplant 2023; 37:e14842. [PMID: 36346070 DOI: 10.1111/ctr.14842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) post-heart transplantation affects 8%-35% of patients; however, the risk profile remains to be completely elucidated. While pre-transplant ICDs are typically removed during transplantation, no information exists to suggest if this pre-transplant risk stratification is also associated with post-transplant outcomes. The objective of this study was to assess the impact of pre-transplant ICD status on long-term prognosis post-heart transplant. METHODS The United Network for Organ Sharing registry was queried for all adult heart transplant recipients from 2010 to 2018. Patients were categorized as with versus without ICD prior to heart transplantation. Survival was compared using Kaplan-Meier analysis. Proportional hazards regression analysis assessed the impact of ICDs adjusting for clinical and demographic covariates. RESULTS Of 19 026 patients included, 78.6% (n = 14 960) had received an ICD at time of registration. Patients with an ICD were older [54.9 (±11.6) years vs. 48.6 (±15.3) years, p < .001], less likely to be female [25.7% (n = 3842) vs. 31.2% (n = 1269), p < .001], and more commonly diabetic [29.3% (n = 4376) vs 23.5% (n = 954), p < .001]. Kaplan-Meier analysis showed no difference in unadjusted survival trajectory by ICD status (chi-square = .48, p = .49). Survival was unrelated to ICD status in the multivariable model (HR = .98; 95% CI .90-1.07). CONCLUSIONS Patients receiving an ICD pre-transplant had a higher prevalence of risk factors for SCD than non-ICD patients, yet ICD status prior to heart transplantation was not associated with a change in long-term prognosis post-heart transplantation.
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Affiliation(s)
- Matthew Dean
- University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Virginia Commonwealth University Health System Internal Medicine Residency, Richmond, Virginia, USA
| | - Cesar Rodrigo Zoni
- University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Cardiothoracic Surgery-Department of Surgery UConn Health, Farmington, Connecticut, USA
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Northampton, Massachusetts, USA.,Department of Population Health and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Christopher Pickett
- University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Chittoor B Sai Sudhakar
- University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Cardiothoracic Surgery-Department of Surgery UConn Health, Farmington, Connecticut, USA
| | - Yazhini Ravi
- University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Cardiothoracic Surgery-Department of Surgery UConn Health, Farmington, Connecticut, USA
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR. The Approach to the Psychosocial Evaluation of Cardiac Transplant and Mechanical Circulatory Support Candidates. Curr Heart Fail Rep 2020; 16:201-211. [PMID: 31782078 DOI: 10.1007/s11897-019-00443-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW We update evidence underlying the recommendations of a 2018 multi-society consensus report regarding the psychosocial evaluation of individuals for cardiothoracic transplantation and mechanical circulatory support (MCS). In the present review, we focus on heart transplantation and MCS. RECENT FINDINGS Expert opinion and new evidence support the inclusion of ten core content areas in the psychosocial evaluation. Prospective data indicate that psychosocial factors can predict post-transplantation/post-implantation outcomes. Such factors include treatment adherence history, mental health and substance use history, cognitive impairment, knowledge about treatment options, and social factors such as socioeconomic status. For other factors (e.g., coping, social support), new evidence is weaker because it derives largely from cross-sectional studies. Concerning evaluation process issues, expert opinion remains consistent with consensus recommendations, but there is a dearth of empirical evidence. The psychosocial evaluation can identify factors relevant for candidacy for heart transplantation and MCS implantation. It enables the provision of interventions to improve patients' viability as candidates, and facilitates care planning.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Andrea F DiMartini
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Miller PE, Pawar S, Vaccaro B, McCullough M, Rao P, Ghosh R, Warier P, Desai NR, Ahmad T. Predictive Abilities of Machine Learning Techniques May Be Limited by Dataset Characteristics: Insights From the UNOS Database. J Card Fail 2019; 25:479-483. [DOI: 10.1016/j.cardfail.2019.01.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/15/2019] [Accepted: 01/23/2019] [Indexed: 12/21/2022]
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Felius J, Hall SA. Employment status at the time of heart transplant listing. J Heart Lung Transplant 2018; 37:575-576. [PMID: 29673653 DOI: 10.1016/j.healun.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott and White Research Institute, Dallas, Texas, USA.
| | - Shelley A Hall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott and White Research Institute, Dallas, Texas, USA; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA; Division of Cardiology, Baylor University Medical Center, Dallas, Texas, USA
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