Factors Associated With Outpatient Palliative Care Use in Patients With Long-Term Left Ventricular Assist Device...

Outpatient palliative care (OPC) has been associated with improved health-related quality of life in patients with heart failure; however, the rate of OPC use for patients with long-term left ventricular assist device (LT-LVAD) use has not been described. In this large cohort of patients living with LT-LVAD therapy, we report on patient outcomes, rates of palliative care use, and factors associated with receiving OPC.

This was a retrospective cohort study of 233 patients with LT-LVAD (defined as patients living with LVAD for at least 6 months after implantation who are ineligible for a heart transplant) with initial LVAD implantation between January 1, 2017, and December 30, 2021. All patients received inpatient palliative care, and some received both outpatient and inpatient palliative care. Multivariate logistic regression models estimated the odds of receiving OPC compared with the group that did not receive OPC and examined the association between patient demographics, clinical outcomes, and social determinants of health (estimated by the Area Deprivation Index).

The cohort had a mean age of 62 years (±12), was 74.2% male, 81.1% Black, with 77.7% receiving HeartMate3, 19.3% HVAD, and 3.0% HeartMate II. In total, 34.3% received OPC, and 65.7% did not receive OPC ("noOPC"). Each additional hospitalization a patient experienced increased the odds of receiving OPC (odds ratio, 1.07; confidence interval [CI], 1.02-1.12, P = .009). Patients with HVAD were less likely to receive OPC than those with HeartMate3 (OR, 0.32; CI, 0.14-0.75, P = .008). There was no statistically significant association between Area Deprivation Index (comparing highest with lowest quartile, representing highest-risk social deprivation profile compared to lowest-risk, respectively) and OPC (OR, 0.50; CI, 0.23-1.10, P = .09). The mean time from first OPC encounter to death was approximately 1 year (standard deviation 0.93).

In this cohort, only 1 of 3 patients with LT-LVAD received OPC. Increased hospitalizations were associated with an increased likelihood of receiving OPC. Patients with HVAD LVADs had lower odds of receiving OPC. These findings highlight an opportunity to proactively integrate OPC into the routine management of patients with LT-LVAD. Developing targeted interventions to improve referral and engagement with palliative care may enhance patient-centered outcomes.