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J Card Fail. 2017 Sep;23(9):708-712. doi: 10.1016/j.cardfail.2016.12.001. Epub 2016 Dec 5.

Deactivation of Left Ventricular Assist Devices: Differing Perspectives of Cardiology and Hospice/Palliative Medicine Clinicians.

Author information

1
Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: colleen.mcilvennan@ucdenver.edu.
2
Department of Medicine, Division of Hematology/Oncology, Palliative Medicine, Mayo Clinic, Phoenix, Arizona.
3
Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
4
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado.
5
University of Colorado College of Nursing, Aurora, Colorado.
6
Department of Cardiovascular Diseases and Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota.
7
Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

BACKGROUND:

Beliefs around deactivation of a left ventricular assist device (LVAD) vary substantially among clinicians, institutions, and patients. Therefore, we sought to understand perspectives regarding LVAD deactivation among cardiology and hospice/palliative medicine (HPM) clinicians.

METHODS AND RESULTS:

We administered a 41-item survey via electronic mail to members of 3 cardiology and 1 HPM professional societies. A convergent parallel mixed-methods design was used. From October through November 2011, 7168 individuals were sent the survey and 440 responded. Three domains emerged: (1) LVAD as a life-sustaining therapy; (2) complexities of the process of LVAD deactivation; and (3) legal and ethical considerations of LVAD deactivation. Most respondents (cardiology 92%; HPM 81%; P = .15) believed that an LVAD is a life-sustaining treatment for patients with advanced heart failure; however, 60% of cardiology vs 2% of HPM clinicians believed a patient should be imminently dying to deactivate an LVAD (P < .001). Additionally, 87% of cardiology vs 100% of HPM clinicians believed the cause of death following LVAD deactivation was from underlying disease (P < .001), with 13% of cardiology clinicians considering it to be a form of euthanasia or physician-assisted suicide.

CONCLUSION:

Cardiology and HPM clinicians have differing perspectives regarding LVAD deactivation. Bridging the gaps and engaging in dialog between these 2 specialties is a critical first step in creating a more cohesive approach to care for LVAD patients.

KEYWORDS:

Heart-assist devices; end of life care; heart failure; palliative care

PMID:
27932271
DOI:
10.1016/j.cardfail.2016.12.001
[Indexed for MEDLINE]

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