Suicide Attempts Among LVAD Recipients: Real-Life Data From the ASSIST-ICD Study.

HomeCirculationVol. 141, No. 11Suicide Attempts Among LVAD Recipients Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessLetterPDF/EPUBSuicide Attempts Among LVAD RecipientsReal-Life Data From the ASSIST-ICD Study Marion Charton, MD, Erwan Flécher, MD, PhD, Christophe Leclercq, MD, PhD, Clément Delmas, MD, Camille Dambrin, MD, PhD, Céline Goeminne, MD, André Vincentelli, MD, PhD, Magali Michel, MD, Laurence Lehelias, MD, Constance Verdonk, MD, Marylou Para, MD, Matteo Pozzi, MD, Jean-François Obadia, MD, PhD, Aude Boignard, MD, Olivier Chavanon, MD, PhD, Laurent Barandon, MD, PhD, Karine Nubret, MD, Michel Kindo, MD, PhD, Tam Hoang Minh, MD, Philippe Gaudard, MD, Edeline Pelcé, MD, Vlad Gariboldi, MD, PhD, Pierre-Yves Litzler, MD, PhD, Frédéric Anselme, MD, Gerard Babatasi, MD, PhD, Annette Belin, MD, Fabien Garnier, MD, Marie Bielefeld, MD, David Hamon, MD, Nicolas Lellouche, MD, PhD, Thierry Bourguignon, MD, Thibaud Genet, MD, Romain Eschalier, MD, PhD, Nicolas D’Ostrevy, MD, Marie-Cécile Bories, MD, Jérôme Jouan, MD, Fabrice Vanhuyse, MD, Hugues Blangy, MD, Julie Doucerain, MD, Raphael P. Martins, MD, PhD and Vincent Galand, MD Marion ChartonMarion Charton INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France. Search for more papers by this author , Erwan FlécherErwan Flécher INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France. Department of Cardiac Surgery and Heart Transplantation Unit (E.F.), CHU Rennes, France. Search for more papers by this author , Christophe LeclercqChristophe Leclercq INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France. Search for more papers by this author , Clément DelmasClément Delmas Centre Hospitalier Universitaire de Toulouse, France (C. Delmas, C. Dambrin). Search for more papers by this author , Camille DambrinCamille Dambrin Centre Hospitalier Universitaire de Toulouse, France (C. Delmas, C. Dambrin). Search for more papers by this author , Céline GoeminneCéline Goeminne Department of Cardiac Surgery, Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, France (C.G., A.V.). Search for more papers by this author , André VincentelliAndré Vincentelli Department of Cardiac Surgery, Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, France (C.G., A.V.). Search for more papers by this author , Magali MichelMagali Michel Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France (M.M., L.L.). Search for more papers by this author , Laurence LeheliasLaurence Lehelias Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France (M.M., L.L.). Search for more papers by this author , Constance VerdonkConstance Verdonk Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France (C.V., M. Para). Search for more papers by this author , Marylou ParaMarylou Para Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France (C.V., M. Para). Search for more papers by this author , Matteo PozziMatteo Pozzi Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France (M. Pozzi, J.-F.O.). Search for more papers by this author , Jean-François ObadiaJean-François Obadia Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France (M. Pozzi, J.-F.O.). Search for more papers by this author , Aude BoignardAude Boignard Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France (A.B., O.C.). Search for more papers by this author , Olivier ChavanonOlivier Chavanon Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France (A.B., O.C.). Search for more papers by this author , Laurent BarandonLaurent Barandon Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, France (L.B., K.N.). Search for more papers by this author , Karine NubretKarine Nubret Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, France (L.B., K.N.). Search for more papers by this author , Michel KindoMichel Kindo Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, France (M.K., T.H.M.). Search for more papers by this author , Tam Hoang MinhTam Hoang Minh Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, France (M.K., T.H.M.). Search for more papers by this author , Philippe GaudardPhilippe Gaudard PhyMedExp, Université de Montpellier, INSERM, CNRS, Arnaud De Villeneuve Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, France (P.G.). Search for more papers by this author , Edeline PelcéEdeline Pelcé Department of Cardiac Surgery, La Timone Hospital, Marseille, France (E.P., V. Gariboldi). Search for more papers by this author , Vlad GariboldiVlad Gariboldi Department of Cardiac Surgery, La Timone Hospital, Marseille, France (E.P., V. Gariboldi). Search for more papers by this author , Pierre-Yves LitzlerPierre-Yves Litzler Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France (P.-Y.L., F.A.). Search for more papers by this author , Frédéric AnselmeFrédéric Anselme Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France (P.-Y.L., F.A.). Search for more papers by this author , Gerard BabatasiGerard Babatasi Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France (G.B., A.B.). Search for more papers by this author , Annette BelinAnnette Belin Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France (G.B., A.B.). Search for more papers by this author , Fabien GarnierFabien Garnier Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France (F.G., M.B.). Search for more papers by this author , Marie BielefeldMarie Bielefeld Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France (F.G., M.B.). Search for more papers by this author , David HamonDavid Hamon Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France (D.H., N.L.). Search for more papers by this author , Nicolas LelloucheNicolas Lellouche Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France (D.H., N.L.). Search for more papers by this author , Thierry BourguignonThierry Bourguignon Department of Cardiology and Cardiac Surgery, Tours University Hospital, France (T.B., T.G.). Search for more papers by this author , Thibaud GenetThibaud Genet Department of Cardiology and Cardiac Surgery, Tours University Hospital, France (T.B., T.G.). Search for more papers by this author , Romain EschalierRomain Eschalier CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France (R.E., N.D.). Search for more papers by this author , Nicolas D’OstrevyNicolas D’Ostrevy CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France (R.E., N.D.). Search for more papers by this author , Marie-Cécile BoriesMarie-Cécile Bories European Georges Pompidou Hospital, Cardiology Department, Paris, France (M.-C.B., J.J.). Search for more papers by this author , Jérôme JouanJérôme Jouan European Georges Pompidou Hospital, Cardiology Department, Paris, France (M.-C.B., J.J.). Search for more papers by this author , Fabrice VanhuyseFabrice Vanhuyse Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France (F.V., H.B.). Search for more papers by this author , Hugues BlangyHugues Blangy Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France (F.V., H.B.). Search for more papers by this author , Julie DoucerainJulie Doucerain Service de Psychiatrie (J.D.), CHU Rennes, France. Search for more papers by this author , Raphael P. MartinsRaphael P. Martins INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France. Search for more papers by this author and Vincent GalandVincent Galand Vincent Galand, MD, CHU Rennes, Rue Henri Le Guilloux, F-35000 Rennes, France. Email E-mail Address: [email protected] INSERM, LTSI-UMR 1099, Univ Rennes (M.C., E.F., C.L., R.P.M., V. Galand), CHU Rennes, France. Search for more papers by this author Originally published10 Mar 2020https://doi.org/10.1161/CIRCULATIONAHA.119.041910Circulation. 2020;141:934–936Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 10, 2020: Ahead of Print Left ventricular assist device (LVAD) implantation is an alternative therapy for end-stage heart failure. Numerous complications are associated with LVADs, including psychiatric disorders such as anxiety and depression. Data regarding the suicide risk in this population are lacking. We aimed at describing the incidence of suicide in LVAD recipients included in the multicenter ASSIST-ICD observational study (Determination of Risk Factors of Ventricular Arrhythmias After Implantation of Continuous Flow Left Ventricular Assist Device With Continuous Flow Left Ventricular Assist Device).ASSIST-ICD (https://www.clinicaltrials.gov; unique identifier: NCT02873169) is a study of LVAD implanted in 19 French centers. Detailed methods have been published.1 Among the 659 LVAD recipients included, 494 (87% men; mean age, 58.9 years [range, 50.3 to 65.8]) were discharged from the hospital and included in this study. History of suicide attempts was reviewed. Clinical data, psychiatric history, and characteristics of suicide or suicide attempts were collected for each patient. The study was approved by an institutional review committee, and the participants gave informed consent.Among the 494 patients, 10 (2.0%) attempted or completed suicide over 18.8 months of follow-up. Eight completed suicide, either by unplugging or sectioning their LVAD cable or drug intoxication; 1 attempted suicide by drug intoxication; and 1 attempted suicide by driveline section. Their characteristics are summarized in the Table. Nine were men, and 2 had a history of a psychiatric disorder. Of note, 8 of 10 (80%) patients were implanted as destination therapy compared with 162 of 484 (33.5%) patients without suicide (P=0.006). Of the 10 patients who attempted or completed suicide, 4 did not have a psychiatric evaluation before LVAD surgery. The median duration of hospital stay after LVAD surgery was 46.5 days (range, 36.0 to 70.0) and suicide attempt occurred on average 12.5 months after the LVAD implantation. Six patients experienced ≤1 hospitalization after initial hospital discharge. A majority of patients (8 of 10) expressed psychiatric symptoms, such as sadness, solitude, or hopelessness. Of 10 patients who attempted or completed suicide, 2 (20%) were followed in a center with an LVAD coordinator compared with 293 of 484 (60.5%) patients without suicide attempt (P=0.02).In France, the suicide attempt rate is ~0.03% per year (200,000 events/year). This frequency increases among patients with chronic diseases such as chronic heart failure (0.06%/year). In our series, the incidence of suicide in LVAD recipients (2% after 18.8 months of follow-up) appears even higher than in those with other chronic diseases. In the INTERMACS registry (Interagency Registry for Mechanically Assisted Circulatory Support), psychiatric episodes were estimated around 1%, but the prevalence of suicide was not specified.2The reasons for the apparently increased incidence of attempted or completed suicide in LVAD recipients are speculative. Our data identified 2 variables that were associated with attempted or completed suicide: implantation for destination therapy and follow-up at a center without an LVAD coordinator. If confirmed by others, the latter is a potentially modifiable practice that could be tested as a means to lower the frequency of suicide. There is plausibility to this finding given that LVAD coordinators are in a unique position, serving as a link between patients’ families and medical teams, and could identify early symptoms of psychiatric disorders. Similarly, staff at cardiac rehabilitation centers may have this opportunity, although our data did not address this possibility. We found a high frequency of psychiatric symptoms (80%) among those who attempted or completed suicide, highlighting the role for psychiatrists as part of a multidisciplinary LVAD team.A number of potential factors, such as alteration of body image, lack of return to full-time employment, feeling burdensome to caregivers, or increased dependence on the medical team, could contribute to the development of psychiatric symptoms in LVAD recipients. Ensuring that patients have rigorous motivation for the treatment, social support, and extensive preoperative education about life after LVAD implantation may mitigate the development of such symptoms. Assessing patients’ satisfaction or decision regret after LVAD implantation could identify those requiring psychological support and detect emerging signs of psychological distress, especially in patients implanted as destination therapy.3In conclusion, we found a 2.0% risk of attempted or completed suicide in LVAD recipients, which is higher than in the general population or those with other chronic diseases in France. These data emphasize the need to develop strategies to minimize the risk of this event in LVAD recipients, especially among those implanted as destination therapy.Table. Patient Characteristics and Follow-UpPatient No.SexAge at LVAD Surgery, y/Duration of Heart Failure, yComorbiditiesHistory of Psychiatric DiseaseSocial SituationPsychiatric Evaluation Before LVADINTERMACSLVADDays in Hospital After LVAD, nNew York Heart Association Classification After LVADSix-Meter Walk Test, mCardiac Events/Symptoms After LVADHospitalization After LVAD, nPsychiatric Symptoms ExpressedMethod of Suicide or Attempted SuicideTime From LVAD to Suicide or Attempt, mo1Male71/17DyslipidemiaNoMarried, 2 childrenNo1DT84IVNAAsthenia0Sadness, solitudeDriveline section3.72Male71/<1Active smokingNoWidower, alone on an island, girlfriend far awayYes2DT28INASevere right ventricular heart failure4Aggressive, sadness, far from homeBattery disconnection153Male59/9Arterial vascular disease, active smoking, alcohol abuseNoMarriedYes≥4DT170II415Numerous LVAD infections1NoDriveline section8.34Female49/10Arterial vascular disease, weaned smoking, obesityDepression, suicide attemptMarried, marital disputeYes≥4DT13I450Asymptomatic1Malaise, marital disputeBattery disconnection25.95Male58/18Arterial vascular disease, ischemic stroke, renal insufficiencyNoMarried, children and grandsonNo2DT70INAAsymptomatic0Hopeless, ruined his lifeDriveline section24.56Male70/<1Active smokingNoMarriedNo1DT48III350Bleeding, pulmonary complication0Failure to thriveDrug intoxication1.27Male50/2Active smokingNoDutch living in France for 14 years, divorced, 2 children, financial difficulties, did not speak FrenchYes≥4Bridge to transplant36II435Asthenia1Sadness, solitudeTwo drug intoxications (suicide attempt)10 and 128Male64/8Obesity, chronic obstructive pulmonary diseaseNoMarried, 3 childrenYes≥4DT45III400Aortic insufficiency, bleeding8Strong care opposition, refused psychiatric careDriveline section589Male56/1ObesityStable schizophreniaIn relationshipYes≥4Bridge to transplant61III300Several LVAD infections4NoDriveline section (suicide attempt)4810Male71/1Chronic obstructive pulmonary disease, strokeNoMarried, marital disputeNo2DT41III410Severe chronic obstructive pulmonary disease2Sadness, no support from his wife, belittled by his wifeBattery disconnection10DT indicates destination therapy; INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support; LVAD, left ventricular assist device; and NA, not available.AcknowledgmentsEditorial support was provided by Dr William J. Hucker.Sources of FundingThis research was supported by the French Federation of Cardiology.DisclosuresNone.FootnotesThe full author list is available on page 935.https://www.ahajournals.org/journal/circThe data, analytic methods, and study materials are not available to other researchers.Vincent Galand, MD, CHU Rennes, Rue Henri Le Guilloux, F-35000 Rennes, France. Email vincent.[email protected]comReferences1. Galand V, Flécher E, Auffret V, Boulé S, Vincentelli A, Dambrin C, Mondoly P, Sacher F, Nubret K, Kindo M, et al; ASSIST-ICD Investigators. Predictors and clinical impact of late ventricular arrhythmias in patients with continuous-flow left ventricular assist devices.JACC Clin Electrophysiol. 2018; 4:1166–1175. doi: 10.1016/j.jacep.2018.05.006CrossrefMedlineGoogle Scholar2. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, Miller MA, Baldwin JT, Young JB. Seventh INTERMACS annual report: 15,000 patients and counting.J Heart Lung Transplant. 2015; 34:1495–1504. doi: 10.1016/j.healun.2015.10.003CrossrefMedlineGoogle Scholar3. Allen LA, McIlvennan CK, Thompson JS, Dunlay SM, LaRue SJ, Lewis EF, Patel CB, Blue L, Fairclough DL, Leister EC, et al. Effectiveness of an intervention supporting shared decision making for destination therapy left ventricular assist device: the DECIDE-LVAD randomized clinical trial.JAMA Intern Med. 2018; 178:520–529. doi: 10.1001/jamainternmed.2017.8713CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rossi Ferrario S, Panzeri A and Pistono M (2021) Psychological difficulties of LVAD patients and caregivers: A follow up over one year from discharge, Artificial Organs, 10.1111/aor.14071, 46:3, (479-490), Online publication date: 1-Mar-2022. Sladen R, Shulman M, Javaid A, Hodgson C, Myles P, Mcgiffin D, Nakagawa S, Amlani A, Hupf J, Takeda K, Naka Y, Takayama H, Bergin P, Buckland M, Yozefpolskaya M and Colombo P (2022) Postdischarge Functional Capacity, Health-Related Quality of Life, Depression, Anxiety, and Post-traumatic Stress Disorder in Patients Receiving a Long-term Left Ventricular Assist Device, Journal of Cardiac Failure, 10.1016/j.cardfail.2021.07.019, 28:1, (83-92), Online publication date: 1-Jan-2022. Chi J, Chen F, Liu Y and Jin L (2022) Suicide risk in patients with heart failure: A systematic review and meta-analysis, Asian Journal of Psychiatry, 10.1016/j.ajp.2021.102980, 68, (102980), Online publication date: 1-Feb-2022. Jiménez-Blanco Bravo M, Zamorano Gómez J, del Prado Díaz S, Alonso Salinas G, Cameli M, Mapelli M, Mango F, Bernstein B and Vervaat F (2021) A suicide attempt on a left ventricular assist device patient during COVID-19 pandemic: can we only blame the virus? 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Choi J, Peters C and Nickels M (2022) Arranging Inpatient Psychiatric Treatment for a Patient with a Left Ventricular Assist Device, Progress in Transplantation, 10.1177/15269248221107033, (152692482211070) March 17, 2020Vol 141, Issue 11 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.041910PMID: 32153210 Originally publishedMarch 10, 2020 KeywordsLVADsuicide attemptPDF download Advertisement SubjectsCardiovascular SurgeryHeart FailureMental Health