Mental Health and Substance Use Disorders in Advanced Heart Failure Patients Undergoing VAD Implantation and Cardiac Transplantation: How Much do We Know?

Abstract

Background: Patients who undergo cardiac transplantation or implantation of LVADs are significantly affected by mental health disorders and substance use problems, which can negatively impact their compliance and quality of life. There is a paucity of research regarding mental health and substance abuse disorders in the post-LVAD implant/ cardiac transplant population. This narrative review will focus on the knowledge gaps

Methods: A qualitative review was performed by conducting a literature search using PubMed and Google Scholar. Adults 18 years and older with LVAD or cardiac transplant were included. The keywords used were anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorders in LVAD patients, and anxiety, depression, mood disorder, panic disorder, PTSD, and adjustment disorder in heart transplant patients. No geographical parameters were used in the search. All papers retrieved were reviewed qualitatively, and relevant information obtained was synthesized to arrive at the results and conclusions presented in this review.

Results: This narrative review showed that anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorder exist in patients undergoing advanced surgical therapies (durable LVADs and cardiac transplantation). Most of the relevant studies are retrospective chart analyses done in single centers. Incidence and prevalence vary widely.

Discussion: This review highlights the importance of mental health surveillance in patients undergoing LVAD and cardiac transplantation to enhance outcomes by improving behavioral health and compliance.

Conclusions: There are no granular guidelines to address psychosocial evaluation in this population. The current literature does not help to distinguish any differences mechanical support would have on the psychology of these patients as compared to cardiac transplantation. Knowledge gaps exist in risk assessment and risk stratification of patients, which need further investigation.