Ventricular Assist Devices for Acute and Chronic Heart Failure
The morbidity and mortality of LVAD complications highlight the importance of palliative care. Advance care planning is recommended for LVAD patients, and the Centers for Medicare and Medicaid Services require that DT LVAD management teams include a palliative care specialist. Palliative care is not synonymous with hospice but rather functions alongside invasive and curative treatments. Palliative care specialists assist patients with defining values and goals that inform decision-making. Swetz et al recommend guiding patients through a 'preparedness plan' to elicit patient wishes in light of potential VAD outcomes that include device failure, intolerable quality of life, catastrophic complications (eg, debilitating stroke) and development of comorbid conditions (eg, metastatic cancer). Of note, the most frequent primary causes of death reported in patients with LVADs are neurological dysfunction (18%), multisystem organ failure (15%), withdrawal of LVAD support (9.6%) and major infection (9.5%). Palliative care consultation can guide symptom relief, particularly important in older patients with multiple symptomatic comorbidities. At the end of patients' lives, palliative care facilitates decision-making about life-sustaining interventions and potential transition to hospice. A growing number of hospices are willing to provide services to patients with active LVADs, in conjunction with an MCS team.
Palliative Care
The morbidity and mortality of LVAD complications highlight the importance of palliative care. Advance care planning is recommended for LVAD patients, and the Centers for Medicare and Medicaid Services require that DT LVAD management teams include a palliative care specialist. Palliative care is not synonymous with hospice but rather functions alongside invasive and curative treatments. Palliative care specialists assist patients with defining values and goals that inform decision-making. Swetz et al recommend guiding patients through a 'preparedness plan' to elicit patient wishes in light of potential VAD outcomes that include device failure, intolerable quality of life, catastrophic complications (eg, debilitating stroke) and development of comorbid conditions (eg, metastatic cancer). Of note, the most frequent primary causes of death reported in patients with LVADs are neurological dysfunction (18%), multisystem organ failure (15%), withdrawal of LVAD support (9.6%) and major infection (9.5%). Palliative care consultation can guide symptom relief, particularly important in older patients with multiple symptomatic comorbidities. At the end of patients' lives, palliative care facilitates decision-making about life-sustaining interventions and potential transition to hospice. A growing number of hospices are willing to provide services to patients with active LVADs, in conjunction with an MCS team.