Patient-centered care for left ventricular assist device therapy

Breathett, Khadijah; Allen, Larry A.; Ambardekar, Amrut V.

doi:10.1097/hco.0000000000000279

Cited by 18 publications

(7 citation statements)

References 41 publications

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“…Patient-centered care for patients with advanced HF requires that patients understand possible outcomes and learn about potential treatment options including LVAD surgery which can improve quality of life and functional capacity for patients limited by HF symptoms, even when death is not imminent. 1,2 However, patients may not full appreciate the invasive procedures that may be required for support during the post-operative period.…”

Section: Introductionmentioning

confidence: 99%

Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure

Ambardekar¹,

Thibodeau

DeVore

et al. 2017

JACC: Heart Failure

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Objectives The aim of this study was to assess patient and physician perceptions of heart failure (HF) disease severity and treatment options. Background The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. Methods Ambulatory patients with advanced HF (NYHA class III–IV, INTERMACS profiles 4–7) on optimized medical therapy were enrolled across 11 centers. At baseline, treating cardiologists rated patients for perceived risk for transplant, LVAD, or death in the upcoming year. Patients were also surveyed about their own perceptions of life expectancy and willingness to undergo various interventions. Results At enrollment, physicians regarded 111 (69%) of the total cohort of 161 patients to be at high risk for transplant, LVAD, or death, while only 23 patients (14%) of patients felt they were at high risk. After a mean follow-up of 13 months, 61 (38%) patients experienced an endpoint with 33 (21%) deaths, 13 (8%) transplants, and 15 (9%) LVAD implants. There was poor discrimination between risk prediction among both patients and physicians. Among physician-identified high risk patients, 77% of patients described willingness to consider LVAD, but 63% indicated that they would decline one or more other simpler forms of life-sustaining therapy such as ventilation, dialysis, or a feeding tube. Conclusions Among patients with advanced HF, physicians identified the majority to be at high risk for transplant, LVAD, or death while few patients recognized themselves to be at high risk. Patients expressed inconsistent attitudes toward lifesaving treatments, possibly indicating poor understanding of these therapies. Educational interventions regarding disease severity and treatment options should be introduced prior to the need for advanced therapies such as intravenous inotropic therapy, transplantation, or LVAD.

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Section: Introductionmentioning

confidence: 99%

Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure

Ambardekar¹,

Thibodeau

DeVore

et al. 2017

JACC: Heart Failure

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“…1 Among patients with advanced heart failure, ventricular assist devices (VAD) extend life expectancy and improve quality of life. 2 However, historically racial/ethnic minorities received less than 1/3 of VADs in the U.S. 3 despite representing 40% of all heart failure hospitalizations and having similar rates of survival compared to Caucasians post VAD. 4,5 The distribution declines further among African-American women, who have the highest prevalence of heart failure compared to all other racial/ethnic groups and sexes.…”

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confidence: 99%

Temporal Trends in Contemporary Use of Ventricular Assist Devices by Race and Ethnicity

Breathett¹,

Allen

Helmkamp

et al. 2018

Circ: Heart Failure

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“…However, DT was not an independent predictor of mortality in our study, probably partly explained by age being in the model but also the low number of patients with DT resulting in a wide confidence interval. Although destination therapy has proven effective in randomized trials [3,9,14] and is accepted by most guidelines [15,16] and payers, the widespread use of destination therapy has been questioned in several settings [17,18]. The Randomized Evaluation of VAD InterVEntion before Inotropic Therapy (REVIVE-IT) trial aimed to extend LVAD use to patients with an estimated 25-30% mortality at one year, corresponding to roughly INTERMACS 5-7 [19].…”

Section: Discussionmentioning

confidence: 99%

Continuous-flow LVADs in the Nordic countries: complications and mortality and its predictors

Braun

Nilsson

Gustafsson

et al. 2019

Scandinavian Cardiovascular Journal

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Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. Design: This was a retrospective, international, multicenter cohort study. Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p < .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p ¼ .046) per 10 years and 0.88 (95% CI [0.72-0.99], p ¼ .044) per 5 mm, respectively. Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.

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Patient-centered care for left ventricular assist device therapy

Cited by 18 publications

References 41 publications

Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure

Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure

Temporal Trends in Contemporary Use of Ventricular Assist Devices by Race and Ethnicity

Continuous-flow LVADs in the Nordic countries: complications and mortality and its predictors

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