scholarly journals Perceptions of Bereaved Caregivers and Clinicians About End‐of‐Life Care for Patients With Destination Therapy Left Ventricular Assist Devices

2021 ◽  
Author(s):  
Sarah Chuzi ◽  
Adeboye Ogunseitan ◽  
Kenzie A. Cameron ◽  
Kathleen Grady ◽  
Lauren Schulze ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Destination Therapy ◽  
Life Care ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Background Patients with left ventricular assist devices (LVADs) implanted as destination therapy may receive suboptimal preparation for and care at the end of life, but there is limited understanding of the reasons for these shortcomings. Exploring perceptions of individuals (caregivers and clinicians) who are closely involved in the end‐of‐life experience with patients with destination therapy LVADs can help identify key opportunities for improving care. Methods and Results We conducted semistructured qualitative interviews with 7 bereaved caregivers of patients with destination therapy LVADs and 10 interdisciplinary LVAD clinicians. Interviews explored perceptions of preparing for end of life, communicating about end of life, and providing and receiving end‐of‐life care, and were analyzed using a 2‐step team‐based inductive approach to coding and analysis. Six themes pertaining to end‐of‐life experiences were derived: (1) timing end‐of‐life discussions in the setting of unpredictable illness trajectories, (2) prioritizing end‐of‐life preparation and decision‐making, (3) communicating uncertainty while providing support and hope, (4) lack of consensus on responsibility for end‐of‐life discussions, (5) perception of the LVAD team as invincible, and (6) divergent perceptions of LVAD withdrawal. Conclusions This study revealed 6 unique aspects of end‐of‐life care for patients with destination therapy LVADs as reported by clinicians and caregivers. Themes coalesced around communication, team‐based care, and challenges unique to patients with LVADs at end of life. Programmatic changes may address some aspects, including training clinicians in LVAD‐specific communication skills. Other aspects, such as standardizing the role of the palliative care team and developing practical interventions that enable timely advance care planning during LVAD care, will require multifaceted interventions.

Abstract 151: End-of-Life Care for Left Ventricular Assist Devices: Differing Perspectives of Cardiology and Palliative Care and Hospice Providers

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Colleen K McIlvennan ◽  
Sara E Wordingham ◽  
Larry A Allen ◽  
Daniel D Matlock ◽  
Jacqueline Jones ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Life Care ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Background: Destination therapy left ventricular assist devices (DT-LVADs) have become a treatment option for carefully selected patients with end-stage heart failure. Death is inevitable despite DT-LVAD, with 1-year mortality approximately 20% and median survival 5 years. However, end-of-life processes for LVAD patients vary significantly by institution, provider, and patient preference. Palliative care has played an increasing role in the care of this patient population, yet there remains little data on the most effective way to integrate palliative care and hospice in the DT-LVAD population. Therefore, we aimed to understand the end-of-life perspectives regarding LVADs among both cardiology and palliative care/hospice providers. Methods: Using internet-based, secure methods, we administered a 41-item survey via electronic mail to members of the American Academy of Hospice and Palliative Medicine, European Society of Cardiology-Heart Failure Association, the International Society for Heart and Lung Transplantation, and the Heart Failure Society of America to assess their perspectives on end-of-life care in patients with LVADs. Descriptive statistics were used to analyze data. Fisher’s exact test was used to compare categorical data. Results: From October to November 2011, there were a total of 440 respondents (palliative care/hospice=137; cardiology=303). Most were physicians (80%; n=320) and male (59%; n=232). The majority of providers in both groups viewed an LVAD as a life-sustaining treatment. The groups differed in their attitudes, beliefs, and comfort with end-of-life care in patients with an LVAD. Few palliative care/hospice providers believed a patient needed to be imminently dying to turn off an LVAD; whereas most cardiology providers noted patients should be imminently dying in order to consider LVAD deactivation (2% vs 60%; p=<0.001). Most palliative care/hospice providers believed requests for turning off an LVAD in a patient who is not nearing death should be honored. In contrast, just over half of cardiology providers contended the request should be honored (88% vs 57%; p=<0.001). The provider groups also disagreed on requiring ethics consultation, with most cardiology providers stating it was necessary prior to turning off an LVAD near the end of life (67% vs 24%; p=<0.001). Conclusion: Cardiology providers and palliative care/hospice providers collectively have different perceptions on management of end of life in patients with an LVAD. Bridging the gaps between these two disciplines is a critical first step in creating a more cohesive approach to end-of-life care for these patients—one that honors autonomy but respects individual provider comfort levels.

Experience With Noncardiac Surgery in Destination Therapy Left Ventricular Assist Devices Patients

ASAIO Journal ◽  
2012 ◽  
Vol 58 (4) ◽  
pp. 396-401 ◽  
Author(s):  
Geetha Bhat ◽  
Shivani Kumar ◽  
Ashim Aggarwal ◽  
Sunil Pauwaa ◽  
German Rossell ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Noncardiac Surgery ◽  
Ventricular Assist Devices ◽  
Destination Therapy ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

scholarly journals Left ventricular assist devices as destination therapy: A new look at survival

2005 ◽  
Vol 129 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Soon J. Park ◽  
Alfred Tector ◽  
William Piccioni ◽  
Edward Raines ◽  
Annetine Gelijns ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Destination Therapy ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist ◽  
New Look

scholarly journals Current Trends in Implantable Left Ventricular Assist Devices

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Jens Garbade ◽  
Hartmuth B. Bittner ◽  
Markus J. Barten ◽  
Friedrich-Wilhelm Mohr
Keyword(s):  
Heart Failure ◽  
Selection Process ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Destination Therapy ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

The shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. Improved results and the increased applicability and durability with left ventricular assist devices (LVADs) have enhanced this treatment option available for end-stage heart failure patients. Moreover, outcome with newer pumps have evolved to destination therapy for such patients. Currently, results using nonpulsatile continuous flow pumps document the evolution in outcomes following destination therapy achieved subsequent to the landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Trial (REMATCH), as well as the outcome of pulsatile designed second-generation LVADs. This review describes the currently available types of LVADs, their clinical use and outcomes, and focuses on the patient selection process.

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