AIMS: Left ventricular assist devices (LVADs) are implanted to support the circulation of patients with advanced heart failure. Patients approaching death, or their surrogates, may request withdrawal of LVAD support. We sought to study the attitudes and practices of heart failure clinicians regarding withdrawal of LVAD support in patients approaching death. METHODS AND RESULTS: Using internet-based and secure methods, we surveyed members of the European Society of Cardiology-Heart Failure Association (ESC-HFA), the International Society for Heart and Lung Transplantation (ISHLT), and the Heart Failure Society of America (HFSA) to assess their attitudes and practices regarding LVAD withdrawal for patients approaching death. The results indicated that clinicians have varied attitudes and practices regarding withdrawing LVAD support in these patients. Furthermore, ESC-HFA clinicians (primarily European) and ISHLT and HFSA clinicians (primarily North American) differed in their attitudes and practices regarding withdrawal of LVAD support, particularly its ethical and legal permissibility. For example, more European clinicians than North American clinicians regarded withdrawing LVAD support as a form of euthanasia. CONCLUSION: Opinions and level of comfort with LVAD withdrawal vary among clinicians. Clinicians should be aware of suggested approaches or guidelines for managing requests for withdrawal of LVAD therapy.
AIMS: Left ventricular assist devices (LVADs) are implanted to support the circulation of patients with advanced heart failure. Patients approaching death, or their surrogates, may request withdrawal of LVAD support. We sought to study the attitudes and practices of heart failure clinicians regarding withdrawal of LVAD support in patients approaching death. METHODS AND RESULTS: Using internet-based and secure methods, we surveyed members of the European Society of Cardiology-Heart Failure Association (ESC-HFA), the International Society for Heart and Lung Transplantation (ISHLT), and the Heart Failure Society of America (HFSA) to assess their attitudes and practices regarding LVAD withdrawal for patients approaching death. The results indicated that clinicians have varied attitudes and practices regarding withdrawing LVAD support in these patients. Furthermore, ESC-HFA clinicians (primarily European) and ISHLT and HFSA clinicians (primarily North American) differed in their attitudes and practices regarding withdrawal of LVAD support, particularly its ethical and legal permissibility. For example, more European clinicians than North American clinicians regarded withdrawing LVAD support as a form of euthanasia. CONCLUSION: Opinions and level of comfort with LVAD withdrawal vary among clinicians. Clinicians should be aware of suggested approaches or guidelines for managing requests for withdrawal of LVAD therapy.
Entities:
Keywords:
End of life; Mechanical circulatory support; Medical ethics; Palliative care; Ventricular assist device
Authors: Shawn R McMahon; Martha Iwamoto; Mehran S Massoudi; Hussain R Yusuf; John M Stevenson; Felicita David; Susan Y Chu; Larry K Pickering Journal: Pediatrics Date: 2003-04 Impact factor: 7.124
Authors: Rachel Lampert; David L Hayes; George J Annas; Margaret A Farley; Nathan E Goldstein; Robert M Hamilton; G Neal Kay; Daniel B Kramer; Paul S Mueller; Luigi Padeletti; Leo Pozuelo; Mark H Schoenfeld; Panos E Vardas; Debra L Wiegand; Richard Zellner Journal: Heart Rhythm Date: 2010-05-14 Impact factor: 6.343
Authors: Keith M Swetz; Monica R Freeman; Omar F AbouEzzeddine; Kari A Carter; Barry A Boilson; Abigale L Ottenberg; Soon J Park; Paul S Mueller Journal: Mayo Clin Proc Date: 2011-06 Impact factor: 7.616
Authors: Mark S Slaughter; Joseph G Rogers; Carmelo A Milano; Stuart D Russell; John V Conte; David Feldman; Benjamin Sun; Antone J Tatooles; Reynolds M Delgado; James W Long; Thomas C Wozniak; Waqas Ghumman; David J Farrar; O Howard Frazier Journal: N Engl J Med Date: 2009-11-17 Impact factor: 91.245
Authors: James K Kirklin; David C Naftel; Robert L Kormos; Lynne W Stevenson; Francis D Pagani; Marissa A Miller; J T Baldwin; J Timothy Baldwin; James B Young Journal: J Heart Lung Transplant Date: 2013-02 Impact factor: 10.247
Authors: Nancy Luo; Joseph G Rogers; Gwen C Dodson; Chetan B Patel; Anthony N Galanos; Carmelo A Milano; Christopher M O'Connor; Robert J Mentz Journal: Am J Cardiol Date: 2016-06-21 Impact factor: 2.778
Authors: Nisha Bansal; Susan M Hailpern; Ronit Katz; Yoshio N Hall; Manjula Kurella Tamura; William Kreuter; Ann M O'Hare Journal: JAMA Intern Med Date: 2018-02-01 Impact factor: 21.873
Authors: Jiayun Xu; Marie T Nolan; Katherine Heinze; Gayane Yenokyan; Mark T Hughes; Julie Johnson; Joan Kub; Carrie Tudor; Daniel P Sulmasy; Lisa Soleymani Lehmann; Joseph J Gallo; Felicia Rockko; Mei Ching Lee Journal: Appl Nurs Res Date: 2015-03-13 Impact factor: 2.257
Authors: Sarah Chuzi; Adeboye Ogunseitan; Kenzie A Cameron; Kathleen Grady; Lauren Schulze; Jane E Wilcox Journal: J Am Heart Assoc Date: 2021-07-26 Impact factor: 5.501