Most patients with a left ventricular assist device (LVAD) died in the hospital, found a recent study of 18,733 patients.1 From 2008 to 2016, 4,916 patients were known to have died. Of this group, 76.9% died in the hospital.

LVADs are becoming increasingly common, and researchers say they expect to see more patients with LVADs dying at home.

“There has been significant effort placed on developing LVAD technology and expanding access, with relatively little inquiry into the inevitable end-of-life process awaiting many patients living with an LVAD,” wrote Colleen McIlvennan, DNP, MS, BSN, the study’s lead author and an assistant professor at the University of Colorado Anschutz Medical Campus in Aurora.

Trial and registry data reported on causes and timing of death of patients with LVADs. “The main motivation for this study was to provide a more granular view of the process of death with an LVAD,” says McIlvennan.

The researchers found variability in patients’ causes of death over time, as well as their health-related quality of life. They did expect to find that most died in the hospital, but were surprised that the percentage has not decreased over time.

“It begs the question of why we have not been able to facilitate deaths outside the hospital for these patients, despite the technology becoming more mainstream,” says McIlvennan.

It is well-established in the literature that most patients prefer to die outside the hospital. “The reasons for patients with LVADs dying in the hospital are likely multifactorial,” says McIlvennan.

There is a low threshold for admission, due to known complications associated with LVAD therapy. Lack of understanding of patient preferences for end-of-life care is another reason. “We, as a community, need to focus on bolstering education and systems of care that address end-of-life needs in this population,” concludes McIlvennan.

REFERENCE

1. McIlvennan CK, Grady KL, Matlock DD, et al. End of life for patients with left ventricular assist devices: Insights from INTERMACS. J Heart Lung Transplant 2018; Dec 15. pii: S1053-2498(18)31784-4. doi: 10.1016/j.healun.2018.12.008. [Epub ahead of print].

SOURCE

• Colleen McIlvennan, DNP, MS, BSN, Assistant Professor, University of Colorado Denver Anschutz Medical Campus, Aurora. Phone: (303) 724-8361. Email: colleen.mcilvennan@ucdenver.edu.