Reasons Why Eligible Candidates Decline Left Ventricular Assist Device Placement

A Patient's Request to Withdraw a Ventricular Assist Device: The Role of the Consulting Psychiatrist Among Evolving Medical Technologies

“…Furthermore, it can be associated with serious postoperative complications, rehospitalization, and long-term medical care. Similar to the patient described in the above case, a substantial number (nearly 20%) of patients with end-stage heart failure choose not to have a ventricular assist device implanted (2,3). Even after ventricular assist device placement, a request for discontinuation is made by up to 20% of patients or their family members (4).…”

Screening for heart transplantation and left ventricular assist system: results from the ScrEEning for advanced Heart Failure treatment (SEE‐HF) study

“…Our study differs from these in that we assessed actual eligibility and interventions rather than survey patient preference. Many patients who initially decline change their mind as symptoms worsen, when it is often too late. Patients consistently underestimate the severity of their prognosis, and in the above survey, nearly all patients would accept an LVAS if they were too ill to get out of bed, which may be too late due to for example peripheral organ or right ventricular failure.…”

Benefits and Challenges of Early Introduction of Left Ventricular Assist Device Placement

“…Referring clinicians should reinforce that LVAD evaluation will need to take place and that candidacy cannot be ensured until a full evaluation is complete. A final practical and ethical challenge that we, like others, have found is that a key factor influencing eligible candidates' declinations of LVAD treatment is that patients often underestimate their illness severity (9)(10)(11). This is particularly the case when they are on OMM, which provides a false sense of security that they are healthier than clinical parameters indicate.…”

“…(7). Patients tend to make decisions about LVAD placement reflexively, which is exacerbated if the evaluation process is perceived as being "hurried" (7,(9)(10)(11). Patients and caregivers may be unable Patients' Perspective on LVAD Timing transfer], we had something to hold on to, and we had had a chance, because we had options" [7].…”