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.

High-quality evidence for the risks and benefits of ambulatory inotrope infusions in advanced HF is limited, particularly when used for palliation. Available data suggest that inotrope therapy improves NYHA functional class and does not impact survival.

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