Ensuring Equitable LVAD Access by Enhancing Psychosocial Risk Assessment

Risk assessments help doctors decide if a patient will benefit from receiving a left ventricular assist device (VAD) to help their heart pump blood to the body. These assessments include medical factors and psychosocial factors – like social support, mental health, and daily living needs. Decisions about whether a patient will benefit and have a good outcome is based on research linking medical and psychosocial factors to post- surgical results. Doctors have strong evidence to guide decisions about medical risks, but there is much less clear guidance about psychosocial factors.
Even though experts agree that psychosocial factors should be reviewed, there is little guidance on how to measure them or what levels should be considered concerning. Because of this, hospitals and care teams often assess these factors in very different ways. This lack of clear standards can force care teams to rely on personal judgment, which may increase the risk of bias and unfair decisions.
The goal of this paper is to suggest practical steps in clinical care, research, and policy to help close this gap. These steps aim to support better, more consistent decision-making when research is limited.