Shunichi Nakagawa1, Arthur R Garan2, Hiroo Takayama3, Koji Takeda3, Veli K Topkara2, Melana Yuzefpolskaya2, Susan X Lin4, Paolo C Colombo2, Yoshifumi Naka3, Craig D Blinderman1. 1. 1 Adult Palliative Care Service, Department of Medicine, Columbia University Medical Center , New York, New York. 2. 2 Division of Cardiology, Department of Medicine, Columbia University Medical Center , New York, New York. 3. 3 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center , New York, New York. 4. 4 Center for Family and Community Medicine, Columbia University Medical Center , New York, New York.
Abstract
BACKGROUND: The difference of end-of-life care for left ventricular assist device (LVAD) patients, between destination therapy (DT) and bridge to transplant (BTT), and the effect of palliative care in this population remain unknown. OBJECTIVE: The primary outcomes of this retrospective cohort study were the place of death, do-not-resuscitate (DNR) order, palliative care consultation in the last month, and hospice enrollment. Secondary outcomes were time on the LVAD, life-sustaining treatment in the last week of life, LVAD deactivation, and clinical trajectory. SETTING/ SUBJECTS: Eighty-nine patients who newly underwent LVAD therapy between 2010 and 2016 and died before May 2017 were divided into DT (59) and BTT (30). RESULTS: At death, BTT patients (61.1 ± 8.9 years) were significantly younger (p = 0.046) than DT patients (65.8 ± 12.9 years). Median (25th-75th percentile) time on LVAD was significantly shorter (p = 0.042) in BTT (152 days, 41.3-375.8) than in DT (358 days, 64-892), but the Kaplan-Meier curves were not significantly different (p = 0.055). The place of death (p = 0.092), DNR order (DT; 70.2%, BTT; 76.7%, p = 0.52), palliative care consultation in the last month (DT; 57.1% and BTT; 41.6%, p = 0.22), and hospice enrollment (DT; 8.5%, BTT; 10.0%, p = 1.0), as well as any of secondary outcomes, were not significantly different between groups. After January 2014, palliative care consultation in the last month increased significantly from 14.2% to 78.9% (p < 0.001), and death in intensive care unit decreased significantly (from 79.4% to 52.8%, p = 0.024) with less frequent mechanical ventilation (from 71.4% to 50.0%, p = 0.047) and renal replacement therapy (42.9% to 19.2%, p = 0.017). CONCLUSIONS: The clinical course of deceased LVAD patients, circumstances, and treatments at the end of life did not differ significantly between the BTT and DT groups. Palliative care consult seemed associated with less resource utilization. Palliative care team should get involved in the care of LVAD patients, not only for DT but also for BTT.
BACKGROUND: The difference of end-of-life care for left ventricular assist device (LVAD) patients, between destination therapy (DT) and bridge to transplant (BTT), and the effect of palliative care in this population remain unknown. OBJECTIVE: The primary outcomes of this retrospective cohort study were the place of death, do-not-resuscitate (DNR) order, palliative care consultation in the last month, and hospice enrollment. Secondary outcomes were time on the LVAD, life-sustaining treatment in the last week of life, LVAD deactivation, and clinical trajectory. SETTING/ SUBJECTS: Eighty-nine patients who newly underwent LVAD therapy between 2010 and 2016 and died before May 2017 were divided into DT (59) and BTT (30). RESULTS: At death, BTTpatients (61.1 ± 8.9 years) were significantly younger (p = 0.046) than DTpatients (65.8 ± 12.9 years). Median (25th-75th percentile) time on LVAD was significantly shorter (p = 0.042) in BTT (152 days, 41.3-375.8) than in DT (358 days, 64-892), but the Kaplan-Meier curves were not significantly different (p = 0.055). The place of death (p = 0.092), DNR order (DT; 70.2%, BTT; 76.7%, p = 0.52), palliative care consultation in the last month (DT; 57.1% and BTT; 41.6%, p = 0.22), and hospice enrollment (DT; 8.5%, BTT; 10.0%, p = 1.0), as well as any of secondary outcomes, were not significantly different between groups. After January 2014, palliative care consultation in the last month increased significantly from 14.2% to 78.9% (p < 0.001), and death in intensive care unit decreased significantly (from 79.4% to 52.8%, p = 0.024) with less frequent mechanical ventilation (from 71.4% to 50.0%, p = 0.047) and renal replacement therapy (42.9% to 19.2%, p = 0.017). CONCLUSIONS: The clinical course of deceased LVAD patients, circumstances, and treatments at the end of life did not differ significantly between the BTT and DT groups. Palliative care consult seemed associated with less resource utilization. Palliative care team should get involved in the care of LVAD patients, not only for DT but also for BTT.
Entities:
Keywords:
end-of-life care; heart failure; left ventricular assist device; mechanical circulatory support; palliative care
Authors: Catherine R Butler; Peter P Reese; James D Perkins; Yoshio N Hall; J Randall Curtis; Manjula Kurella Tamura; Ann M O'Hare Journal: J Am Soc Nephrol Date: 2020-09-09 Impact factor: 10.121
Authors: Theresa Tenge; David Santer; Daniel Schlieper; Manuela Schallenburger; Jacqueline Schwartz; Stefan Meier; Payam Akhyari; Otmar Pfister; Silke Walter; Sandra Eckstein; Friedrich Eckstein; Martin Siegemund; Jan Gaertner; Martin Neukirchen Journal: Front Cardiovasc Med Date: 2022-06-29