Dying With a Left Ventricular Assist Device as Destination Therapy

Circ Heart Fail. 2016 Oct;9(10):e003096. doi: 10.1161/CIRCHEARTFAILURE.116.003096.


Background: Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive.

Methods and results: All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record. Of 89 patients who died with a DT-LVAD, the median (25th-75th percentile) time from left ventricular assist device implantation to death was 14 (4-31) months. The most common causes of death were multiorgan failure (26%), hemorrhagic stroke (24%), and progressive heart failure (21%). Nearly half (46%) of the patients saw palliative care within 1 month before death; however, only 13 (15%) patients enrolled in hospice a median 11 (range 1-315) days before death. Most patients (78%) died in the hospital, of which 88% died in the intensive care unit. In total, 49 patients had their left ventricular assist device deactivated before death, with all but 3 undergoing deactivation in the hospital. Most patients died within an hour of left ventricular assist device deactivation and all within 26 hours.

Conclusions: In contrast to the general heart failure population, most patients with DT-LVAD die in the hospital and few use hospice. Further work is needed to understand these differences and to determine whether patients with DT-LVAD are receiving optimal end-of-life care.

Keywords: end-of-life care; heart failure; left ventricular assist device; morbidity/mortality.

MeSH terms

  • Aged
  • Cause of Death
  • Disease Progression
  • Female
  • Heart Failure / therapy*
  • Heart-Assist Devices*
  • Hospice Care / statistics & numerical data*
  • Humans
  • Intensive Care Units
  • Intracranial Hemorrhages
  • Male
  • Middle Aged
  • Multiple Organ Failure
  • Palliative Care / statistics & numerical data*
  • Referral and Consultation
  • Retrospective Studies
  • Stroke
  • Survival Rate
  • Terminal Care / statistics & numerical data*
  • Withholding Treatment / statistics & numerical data*