Bereaved Caregiver Perspectives on the End-of-Life Experience of Patients With a Left Ventricular Assist Device

McIlvennan, Colleen K.; Jones, Jacqueline; Allen, Larry A.; Swetz, Keith M.; Nowels, Carolyn T.; Matlock, Daniel D.

doi:10.1001/jamainternmed.2015.8528

Cited by 77 publications

(69 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, we need a better understanding of the reasons that hospice use is so low and in-hospital death is so high in this population. A recent qualitative study of 8 bereaved caregivers of patients with LVAD found that caregivers felt confused about the involvement of other care providers, such as palliative care and hospice clinicians, at the end of their loved one’s life 21 . Further qualitative inquiry to include various stakeholders such as physicians, LVAD coordinators, social workers, patients, and caregivers are needed to fully delineate the factors that may be contributing to our observations.…”

Section: Discussionmentioning

confidence: 99%

Dying With a Left Ventricular Assist Device as Destination Therapy

Dunlay

Strand

Wordingham

et al. 2016

Circ: Heart Failure

Self Cite

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

Dying With a Left Ventricular Assist Device as Destination Therapy

Dunlay

Strand

Wordingham

et al. 2016

Circ: Heart Failure

Self Cite

View full text Add to dashboard Cite

show abstract

“…Discussions around end of life and deactivation in people with LVADs are especially complicated. 88 With DT-LVADs, death will occur with the LVAD in place. The opinions and comfort levels of providers around LVAD deactivation are varied, with some providers viewing it as an act of euthanasia.…”

Section: Left Ventricular Assist Devicesmentioning

confidence: 99%

Palliative care in patients with heart failure

McIlvennan

Allen

2016

BMJ

145

148

View full text Add to dashboard Cite

Despite advances in cardiac therapy, heart failure (HF) remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, and healthcare systems. Palliative care is a multidisciplinary approach to care that focuses on communication, shared decision making, and advance care planning; provides relief from pain and other distressing symptoms; integrates psychological and spiritual aspects of care; and offers a support system to help families cope during illness and bereavement. Palliative care has applications across the stages of heart failure, including early in the course of illness, often in conjunction with other therapies that are intended to prolong life. However, the incorporation of palliative care into the management of heart failure has been suboptimal for several reasons: uncertainty in the disease trajectory, failure to reward communication between healthcare providers and patients, siloed care, lack of knowledge, overlay of comorbidity and frailty, life saving devices with complex trade-offs, and a limited evidence base. This review will summarize the current literature on the emerging role of palliative care in patients with heart failure and the challenges and opportunities for its integration into routine care. It will discuss current initiatives and future directions of the collaborative relationship between the palliative care and heart failure disciplines.

show abstract

“…3 It is particularly important to discuss the complications that can occur with an LVAD as they are more common than in many other types of surgery and can have a dramatic impact on a patient's quality of life (eg, a debilitating stroke). This is tough because the therapy can also be life-saving-and sometimes clinicians may struggle with their desire to give patients every shot imaginable.…”

Section: See Viewpoint By Kane and Meadowsmentioning

confidence: 99%

Clinical Commentary on “Finding a Better Way”

Hummel

2017

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Bereaved Caregiver Perspectives on the End-of-Life Experience of Patients With a Left Ventricular Assist Device

Cited by 77 publications

References 23 publications

Dying With a Left Ventricular Assist Device as Destination Therapy

Dying With a Left Ventricular Assist Device as Destination Therapy

Palliative care in patients with heart failure

Clinical Commentary on “Finding a Better Way”

Contact Info

Product

Resources

About