Improving end-of-life care for ventricular assist devices (VAD) patients: paradox or protocol?*

When a person consents to have a ventricular assist device (VAD) implanted in one's heart, the intention is to extend life toward a new heart or toward more time. Complications may develop followed by frequent hospital admissions-most often in an intensive care unit (ICU) setting-rendering a transplant a distant reality and to discontinue the device means certain death. Emotional support for patient and family is critical. Regardless of the original goal for the device, palliative care provides assistance in communication, goal setting, and symptom management and yet its consultation is often more for brink-of-death care than end-of-life care provided at the time of diagnosis of a life-threatening disease such as heart failure. This study examined the recent deaths of hospitalized patients with VADs and the use of the palliative care service. Understanding the benefit and timing of palliative care for VAD patients-particularly in the ICU setting--may improve the end-of-life experience for patients, families, and healthcare providers.