Dying With a Left Ventricular Assist Device as Destination Therapy

Area of Science:

• Cardiology
• Palliative Care
• Medical Devices

Background:

• Destination therapy left ventricular assist devices (DT-LVAD) extend survival for advanced heart failure patients.
• Limited data exists on end-of-life care experiences for patients with DT-LVAD.

Purpose of the Study:

• To investigate the characteristics of end-of-life care received by patients with DT-LVAD.
• To compare end-of-life care patterns in DT-LVAD patients with the general heart failure population.

Main Methods:

• Retrospective review of electronic medical records for patients who died with DT-LVAD at Mayo Clinic (2007-2014).
• Analysis of causes of death, timing of palliative care and hospice enrollment, place of death, and left ventricular assist device deactivation.

Main Results:

• Of 89 deceased DT-LVAD patients, common causes of death included multiorgan failure (26%), hemorrhagic stroke (24%), and progressive heart failure (21%).
• Nearly half received palliative care within a month of death, but only 15% enrolled in hospice.
• Most patients (78%) died in the hospital, often in the ICU, with device deactivation occurring prior to death.

Conclusions:

• DT-LVAD patients exhibit different end-of-life care patterns compared to the general heart failure population, with higher in-hospital mortality and lower hospice utilization.
• Further investigation is required to optimize end-of-life care for patients with DT-LVAD.