Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

Kitko, Lisa; Hupcey, Judith E.; Birriel, Barbara; Alonso, Windy

doi:10.1016/j.hrtlng.2015.12.003

Cited by 40 publications

(32 citation statements)

References 25 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…25 As a result, a recent study found that most patients expect greater improvements in their quality of life than they often experience. 26 There is a pressing need to improve communication with patients prior to LVAD and to provide more realistic estimates of recovery. The use of an outcome that incorporates both survival and quality of life is likely to be an efficient means for communicating to patients the information they most value in making a decision, particularly because the KCCQ integrates numerous health status characteristics that patients care about, including heart failure symptoms, functional limitations, social limitations, and quality of life.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Poor Outcome (Death or Poor Quality of Life) After Left Ventricular Assist Device for Destination Therapy

Arnold

Jones

Allen

et al. 2016

Circ: Heart Failure

View full text Add to dashboard Cite

Background A left ventricular assist device (LVAD) improves survival and quality of life for many, but not all, patients with end-stage heart failure who are ineligible for transplantation. We sought to evaluate the frequency of poor outcomes using a novel composite measure that integrates quality of life with mortality. Methods and Results Within the INTERMACS national registry, poor outcome was defined as death or an average Kansas City Cardiomyopathy Questionnaire<45 over the year following LVAD (persistently limiting heart failure symptoms and poor quality of life). Among 1638 LVAD patients, 29.7% had a poor outcome, with death in 22.4% and persistently poor quality of life in 7.3%. Patients who had a poor outcome were more likely to have higher body mass indices (29.3 vs. 28.2 kg/m2, p=0.007), lower hemoglobin levels (11.1 vs. 11.4 g/dL, p=0.005), prior cardiac surgery (47.8% vs. 39.8%, p=0.004), history of cancer (13.8% vs. 9.7%, p=0.025), severe diabetes (15.6% vs. 11.5%, p=0.038), and poorer quality of life pre-implant (KCCQ scores: 29.8 vs. 35.3, p<0.001). Conclusions Nearly one-third of patients die or have a persistently poor quality of life over the year after LVAD. We identified a number of factors associated with a poor outcome, which may inform discussions prior to LVAD implantation to enable more realistic expectations of recovery.

show abstract

Section: Discussionmentioning

confidence: 99%

Frequency of Poor Outcome (Death or Poor Quality of Life) After Left Ventricular Assist Device for Destination Therapy

Arnold

Jones

Allen

et al. 2016

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…It is a biotechnological device replacing the function of the left ventricle of the heart in systemic circulation by increasing blood flow from the left ventricle into the aorta (Gustafsson & Rogers, 2017). These devices are not curative (but see Birks et al, 2006 andSelzman et al, 2015 for their use as bridge to recovery and removal); nevertheless, they alleviate symptoms and prolong survival (Kitko, Hupcey, Birriel, & Alonso, 2016). LVAD can be designated as a bridge to transplantation (BTT) to keep patients alive while waiting for a transplant or as a destination therapy (DT) for patients who are ineligible for transplantation but are willing to undergo the implantation procedure to improve quality of life (QOL) (Rector & Taylor, 2012) and, recently, for a few usually younger patients, bridge to recovery allowing the myocardium time to heal (Selzman et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

Delmaczynska

Newham

2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: a review. Background End‐stage heart failure is associated with significant symptom burden at rest. Left ventricular assist devices are not curative; nevertheless, they alleviate symptoms and prolong survival. Evidence suggests that most patients with left ventricular assist devices and their families do not have open discussions regarding end‐of‐life wishes until catastrophic complications arise. Therefore, it is important to understand reasons for this, so healthcare professionals such as nurses can facilitate the process. Design A mixed‐studies integrative review with a narrative synthesis of the evidence. PRISMA guidelines were followed for reporting systematic qualitative reviews. Method A search of four electronic data in January 2018 and a hand search yielded 139 citations; seven studies met the review eligibility criteria. Methodological quality of the selected studies was evaluated, and data were extracted and compiled. Results Three themes were identified: prevalence and feasibility of advanced care planning, advance care planning developed for patients with device support, patients’ and caregivers’ perceptions of advanced care planning discussions. Advanced care planning is underused routinely implemented in left ventricular device centres. Pre‐implantation advanced care planning is feasible and results in the highest rate of documented advance decisions which are useful for both patients and their loved ones in cases of complications. Conclusion Strong evidence that left ventricular assist‐specific advanced care planning is recommended for all left ventricular assist device patients to enable their treatment preferences in case of incurable complications. Palliative care services should collaborate with nurses in designing and facilitating advanced care planning for delisted transplant patients. Patients with left ventricular devices awaiting heart transplant and those waiting for myocardium healing are underrepresented in the current studies. Research on the optimal timing of advanced care planning in these groups of patients is indicated. Relevance for clinical practice There is a need for improved approaches to advanced care planning for and with people with left ventricular devices.

show abstract

“…3e6 Implantation entails a drastic change in lifestyle for both patients and their caregivers, and even with an LVAD, many of these patients are in the last months to years of life and require advance care planning (ACP) and support. 5,7 The dying process can become prolonged and complicated for patients with an LVAD implanted. 6e9 Historically, many of these patients had not considered under what conditions they would want to have the LVAD deactivated and have not made their end-of-life wishes known to friends, family, or health care proxies, 5,10,11 leading to burden and confusion among bereaved caregivers.…”

Section: Introductionmentioning

confidence: 99%

“…5,7 The dying process can become prolonged and complicated for patients with an LVAD implanted. 6e9 Historically, many of these patients had not considered under what conditions they would want to have the LVAD deactivated and have not made their end-of-life wishes known to friends, family, or health care proxies, 5,10,11 leading to burden and confusion among bereaved caregivers. 6,12 Furthermore, although LVADs can improve symptomatic heart failure and quality of life, many patients with LVADs may continue to experience burdensome chronic symptoms and may also develop symptoms related to LVAD implantation and complications thereof.…”

Section: Introductionmentioning

confidence: 99%

“…6,12 Furthermore, although LVADs can improve symptomatic heart failure and quality of life, many patients with LVADs may continue to experience burdensome chronic symptoms and may also develop symptoms related to LVAD implantation and complications thereof. 5 Because of their expertise in ACP, family and patient support, and symptom management, palliative care providers are an ideal addition to the LVAD treatment team. 13,14 As of 2014, evaluation by a palliative care specialist before consideration of LVAD placement is a requirement of The Joint Commission (TJC) for advanced certification in Ventricular Assist Device for Destination Therapy, 15 and the Centers for Medicare & Medicaid Services require all programs that implant ventricular assist devices as DT to include a palliative care specialist as a member of the mechanical circulatory support team, although the role of this individual is not specified.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementing Routine Palliative Care Consultation Before LVAD Implantation: A Single Center Experience

Salomon¹,

Frankel

Chuang

et al. 2018

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Although palliative care consultants provided initial evaluation and management of multiple symptoms, there was not a large ongoing need. Integration of palliative services into the care of patients receiving LVADs can be incorporated into the workflow of the cardiothoracic and palliative care teams, resulting in improved ACP for all patients receiving LVADs and better care coordination for patients at the end of life.

show abstract

Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

Cited by 40 publications

References 25 publications

Frequency of Poor Outcome (Death or Poor Quality of Life) After Left Ventricular Assist Device for Destination Therapy

Frequency of Poor Outcome (Death or Poor Quality of Life) After Left Ventricular Assist Device for Destination Therapy

To explore the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: A review

Implementing Routine Palliative Care Consultation Before LVAD Implantation: A Single Center Experience

Contact Info

Product

Resources

About