Inpatient Specialist Palliative Care in Patients With Left Ventricular Assist Devices (LVAD): A Retrospective Case Series

Frontiers in Cardiovascular Medicine

article

Theresa Tenge¹  David Santer³  Daniel Schlieper²  Manuela Schallenburger²  Jacqueline Schwartz²  Stefan Meier¹  Payam Akhyari⁴  Otmar Pfister⁵  Silke Walter⁶  Sandra Eckstein⁶  Friedrich Eckstein³  Martin Siegemund⁸  Jan Gaertner^1,10  Martin Neukirchen¹ 

[1] Department of Anesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University;Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University;Department of Cardiac Surgery, University Hospital Basel;Department of Cardiovascular Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University;Department of Cardiology, University Hospital Basel;Department of Palliative Care, University Hospital Basel;Department of Practice Development Nursing, University Hospital Basel;Intensive Care Unit, University Hospital Basel;Department of Clinical Research, University of Basel;Faculty of Medicine, University of Basel;Palliative Care Center Hildegard

关键词: heart assist devices;    left ventricular assist devices;    heart failure;    palliative care;    end of life care;    quality of life;    cardiac surgery;   

DOI  :  10.3389/fcvm.2022.879378

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Repeat hospitalizations, complications, and psychosocial burdens are common in patients with left ventricular assist devices (LVAD). Specialist palliative care (sPC) involvement supports patients during decision-making until end-of-life. In the United States, guidelines recommend early specialist palliative care (esPC) involvement prior to implantation. Yet, data about sPC and esPC involvement in Europe are scarce. Materials and Methods This is a retrospective descriptive study of deceased LVAD patients who had received sPC during their LVAD-related admissions to two university hospitals in Duesseldorf, Germany and Basel, Switzerland from 2010 to 2021. The main objectives were to assess: To which extent have LVAD patients received sPC, how early is sPC involved? What are the characteristics of those, how did sPC take place and what are key challenges in end-of-life care? Results In total, 288 patients were implanted with a LVAD, including 31 who received sPC (11%). Twenty-two deceased LVAD patients (19 male) with sPC were included. Mean patient age at the time of implantation was 67 (range 49–79) years. Thirteen patients (59%) received LVAD as destination therapy, eight patients (36%) were implanted as bridge to transplantation (BTT), and one as an emergency LVAD after cardiogenic shock (5%). None of the eight BTT patients received a heart transplantation before dying. Most ( n = 13) patients lived with their family and mean Eastern Cooperative Oncology Group (ECOG) performance status was three. Mean time between LVAD implantation and first sPC contact was 1.71 years, with a range of first sPC contact from 49 days prior to implantation to more than 6 years after. Two patients received esPC before implantation. In Duesseldorf, mean time between first sPC contact and in-hospital death was 10.2 (1–42) days. In Basel, patients died 16 (0.7–44) months after first sPC contact, only one died on the external sPC unit. Based on thorough examination of two case reports, we describe key challenges of sPC in LVAD patients including the necessity for sPC expertise, ethical and communicative issues as well as the available resources in this setting. Conclusion Despite unequivocal recommendations for sPC in LVAD patients, the integration of sPC for these patients is yet not well established.

【 授权许可】

CC BY