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LVAD Bridge Duration, Post-transplant Employment, and Return to Work: A National Registry Analysis of Heart
Ahmed A Zayed1, Mohammad Ennab2, Mohamad Bahij Moumneh1
1Northwell Health, Cardiovascular Institute, Staten Island University Hospital, Staten Island, NY, USA.
Background:
The 2018 United Network for Organ Sharing (UNOS) heart allocation policy change has substantially altered left ventricular assist device (LVAD) bridge duration before heart transplantation. Whether prolonged durable mechanical circulatory support is associated with impaired post-transplant employment, including return to work (RTW) among previously employed patients, remains uncertain.
Methods:
We performed a retrospective cohort study of 9473 adult LVAD-bridged heart transplant recipients (2010-2023) using the UNOS/Scientific Registry of Transplant Recipients (SRTR) database. The primary outcome was post-transplant employment at 1 year. A key secondary outcome was RTW among patients employed at the time of listing. Bridge duration was categorized as < 6, 6-12, 12-24, and > 24 months. Multivariable logistic regression adjusted for demographic, socioeconomic, and clinical factors.
Results:
Median bridge duration was 12.4 months (IQR 6.3-23.8); 21.2% of patients were employed at 1 year (1,662/7,845). Longer bridge duration was associated with lower employment in unadjusted analysis (> 24 vs < 6 months: OR 0.76, 95% CI 0.65-0.89), but this association was attenuated after adjustment (adjusted OR 0.90, 95% CI 0.75-1.08, p = 0.258). Among 1,132 patients employed at listing with available follow-up data, 56.4% returned to work at 1 year; the adjusted association with bridge duration was similarly non-significant (> 24 vs < 6 months: OR 0.74, 95% CI 0.50-1.08, p = 0.116). Pre-transplant employment (OR 5.30), college education (OR 1.81), and private insurance (Medicare OR 0.41; Medicaid OR 0.45) were the strongest independent predictors. Findings were consistent across subgroups, sensitivity analyses, and allocation policy eras.
Conclusion:
LVAD bridge duration was not independently associated with post-transplant employment or RTW after multivariable adjustment. Socioeconomic and demographic factors-not bridge duration-were the strongest correlates of vocational outcomes. These findings are consistent with the potential value of early, integrated vocational and social interventions across the LVAD-to-transplant continuum.
