Patients' Perspectives on Transplantation While Undergoing Left Ventricular Assist Device Support.

Area of Science:

• Cardiology
• Medical Technology
• Patient Care

Background:

• Advanced heart failure necessitates mechanical circulatory support.
• Left-ventricular assist device (LVAD) therapy is a common treatment.
• Clinician assumption: patients prefer heart transplant over LVAD.

Purpose of the Study:

• Investigate patient treatment preferences for LVAD vs. heart transplantation.
• Understand decisional processes and preferences in advanced heart failure patients.
• Clarify nuances beyond the clinician assumption.

Main Methods:

• Qualitative descriptive study with constant comparisons.
• Structured, in-depth interviews with 60 participants (LVAD patients, candidates, decliners, caregivers).
• Interviews guided by the Ottawa framework on decision-making.

Main Results:

• While initially preferring transplant, some LVAD patients develop ambivalence.
• Concerns about multiple surgeries and lifestyle changes with transplantation emerged.
• Some patients preferred LVAD as destination therapy due to life satisfaction and a "new normal".

Conclusions:

• Patient experience with LVAD can shift preferences away from transplantation.
• Some patients may prefer LVAD as a long-term solution even if transplant-eligible.
• Clinical recommendations needed to address evolving patient goals and preferences.