Dying with a Left Ventricular Assist Device as Destination Therapy

Shannon M. Dunlay, Jacob J. Strand, Sara E. Wordingham, John M. Stulak, Angela J. Luckhardt, Keith M. Swetz

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Background - Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive. Methods and Results - All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record. Of 89 patients who died with a DT-LVAD, the median (25th-75th percentile) time from left ventricular assist device implantation to death was 14 (4-31) months. The most common causes of death were multiorgan failure (26%), hemorrhagic stroke (24%), and progressive heart failure (21%). Nearly half (46%) of the patients saw palliative care within 1 month before death; however, only 13 (15%) patients enrolled in hospice a median 11 (range 1-315) days before death. Most patients (78%) died in the hospital, of which 88% died in the intensive care unit. In total, 49 patients had their left ventricular assist device deactivated before death, with all but 3 undergoing deactivation in the hospital. Most patients died within an hour of left ventricular assist device deactivation and all within 26 hours. Conclusions - In contrast to the general heart failure population, most patients with DT-LVAD die in the hospital and few use hospice. Further work is needed to understand these differences and to determine whether patients with DT-LVAD are receiving optimal end-of-life care.

Original languageEnglish (US)
JournalCirculation: Heart Failure
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • end-of-life care
  • heart failure
  • left ventricular assist device
  • morbidity/mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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