Colleen K McIlvennan1, Kathleen L Grady2, Daniel D Matlock3, Laura J Helmkamp4, Martha Abshire5, Larry A Allen6. 1. Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address: colleen.mcilvennan@ucdenver.edu. 2. Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. 3. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA; Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado, USA. 4. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA. 5. Johns Hopkins University School of Nursing, Baltimore, Maryland, USA. 6. Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA.
Abstract
BACKGROUND: Trial and registry data have reported mortality rates and causes of death in patients with left ventricular assist devices (LVADs); however, a more granular description is needed of end of life, including location of death and quality of life (QOL), to better guide expectations and care. METHODS: To identify where patients with an LVAD died, characterize QOL before death, and cause of death over time, we evaluated patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) implanted with a continuous-flow LVAD. RESULTS: From 18,733 patients implanted with an LVAD during the period 2008 to 2016, 4,916 patients were known to have died, of whom 98% had a recorded location of death. Overall, 76.9% died in the hospital, with progressively more patients dying outside of the hospital further post-LVAD implant: <1 month, 2.3%; 1 to 12 months, and 16.8%; and >12 months, 37.4%. In a multivariable analysis, increased age (RR (risk ratio) 1.06, 95% confidence interval [CI] 1.02 to 1.12, p = 0.01) and destination therapy indication (RR 1.15, 95% CI 1.03 to 1.28, p = 0.01) increased the likelihood of dying outside the hospital. Comparing 3 months post-implant with 6 months before death in a subset of patients, QOL remained clinically stable (EQ-5D Visual Analog Scale [mean ± SD]: 68.3 ± 22.2 to 66.7 ± 21.7, p = 0.11; KCCQ: 61.0 ± 22.2 to 57.8 ± 23.2, p = 0.003). The most common cause of death <1 month post-implant was multiple-organ failure (20.4%) and at >1 month post-implant it was neurologic dysfunction (28.2%). CONCLUSIONS: Most patients with an LVAD died in the hospital. QOL remained stable months before death and causes of death were varied, but increasingly dominated by stroke. By understanding death with an LVAD in place, clinicians are in a better position to educate patients and caregivers about what to expect and provide to support tailored to patient and caregiver needs.
BACKGROUND: Trial and registry data have reported mortality rates and causes of death in patients with left ventricular assist devices (LVADs); however, a more granular description is needed of end of life, including location of death and quality of life (QOL), to better guide expectations and care. METHODS: To identify where patients with an LVAD died, characterize QOL before death, and cause of death over time, we evaluated patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) implanted with a continuous-flow LVAD. RESULTS: From 18,733 patients implanted with an LVAD during the period 2008 to 2016, 4,916 patients were known to have died, of whom 98% had a recorded location of death. Overall, 76.9% died in the hospital, with progressively more patients dying outside of the hospital further post-LVAD implant: <1 month, 2.3%; 1 to 12 months, and 16.8%; and >12 months, 37.4%. In a multivariable analysis, increased age (RR (risk ratio) 1.06, 95% confidence interval [CI] 1.02 to 1.12, p = 0.01) and destination therapy indication (RR 1.15, 95% CI 1.03 to 1.28, p = 0.01) increased the likelihood of dying outside the hospital. Comparing 3 months post-implant with 6 months before death in a subset of patients, QOL remained clinically stable (EQ-5D Visual Analog Scale [mean ± SD]: 68.3 ± 22.2 to 66.7 ± 21.7, p = 0.11; KCCQ: 61.0 ± 22.2 to 57.8 ± 23.2, p = 0.003). The most common cause of death <1 month post-implant was multiple-organ failure (20.4%) and at >1 month post-implant it was neurologic dysfunction (28.2%). CONCLUSIONS: Most patients with an LVAD died in the hospital. QOL remained stable months before death and causes of death were varied, but increasingly dominated by stroke. By understanding death with an LVAD in place, clinicians are in a better position to educate patients and caregivers about what to expect and provide to support tailored to patient and caregiver needs.
Authors: Sakir Akin; Osama Soliman; Theo M M H de By; Rahatullah Muslem; Jan G P Tijssen; Felix Schoenrath; Bart Meyns; Jan F Gummert; Paul Mohacsi; Kadir Caliskan Journal: Intensive Care Med Date: 2020-02-03 Impact factor: 17.440
Authors: Lieke Numan; Faiz Z Ramjankhan; Daniel L Oberski; Martinus I F J Oerlemans; Emmeke Aarts; Monica Gianoli; Joris J Van Der Heijden; Nicolaas De Jonge; Niels P Van Der Kaaij; Christiaan L Meuwese; Mostafa M Mokhles; Anne-Marie Oppelaar; Eric E C De Waal; Folkert W Asselbergs; Linda W Van Laake Journal: ESC Heart Fail Date: 2021-02-26
Authors: Christian Sohns; Henrik Fox; Leonard Bergau; Philipp Sommer; Mustapha El Hamriti; Michel Morshuis; Denise Guckel; René Schramm; Sebastian V Rojas; Guram Imnadze; Jan F Gummert Journal: Clin Res Cardiol Date: 2021-10-28 Impact factor: 5.460