Reasons Why Eligible Candidates Decline Left Ventricular Assist Device Placement

Area of Science:

• Cardiology
• Medical Ethics
• Patient Decision-Making

Background:

• Understanding patient beliefs and perceptions is vital for informed consent regarding left ventricular assist device (LVAD) placement.
• Investigating factors influencing LVAD placement refusal and decision changes is essential for improving patient care.

Purpose of the Study:

• To explore the factors influencing patient decisions to refuse left ventricular assist device (LVAD) implantation.
• To analyze the evolving decision-making process of patients who initially decline LVAD but later accept it.

Main Methods:

• Conducted structured interviews with 21 patients who declined LVAD placement.
• Analyzed interview transcripts quantitatively using Atlas.ti software.
• Included both prospectively and retrospectively identified LVAD decliners.

Main Results:

• Eleven patients persistently declined LVAD, while ten initially refused but later accepted the device.
• Decision changes were often prompted by worsening symptoms.
• Key concerns included impact on mobility, distrust of technology, perceived impact on transplant eligibility, and feeling "not sick enough".

Conclusions:

• Patient perspectives are critical for refining informed consent and refusal processes for LVAD implantation.
• Decision-making regarding LVAD placement is dynamic and influenced by evolving symptoms and specific patient concerns.
• Clinical recommendations can be developed to address patient beliefs and improve the LVAD decision-making pathway.