Perspectives on End of Life With Left Ventricular Assist Device

Study Questions:

What is the experience of bereaved caregivers and patients at the end of life who have a left ventricular assist device (LVAD)?

Methods:

Semistructured, in-depth interviews were conducted between September 10 and November 21, 2014, with eight bereaved caregivers of patients with an LVAD who were recruited from a single institution. Data were analyzed from December 13, 2014, to February 18, 2015, using a mixed inductive and deductive approach. The main outcome measures were themes from semistructured interviews.

Results:

The eight caregivers (six females) described three main themes that coalesced around feelings of confusion in the final weeks with their loved ones: 1) the process of death with an LVAD, 2) the legal and ethically permissible care of patients with an LVAD approaching death, and 3) fragmented integration of palliative and hospice care.

Conclusions:

The authors concluded that despite increasing use of LVADs in patients with advanced heart failure, bereaved caregivers of patients with an LVAD describe a high level of confusion at the end of life.

Perspective:

This study reports that despite the increasing use of LVADs in patients with advanced heart failure, bereaved caregivers of these patients describe a high level of confusion at the end of life, about the nature of the death, about the medical decisions to be made, and about the palliative care and hospice services provided. Future initiatives should focus on education for patients and their loved ones, including the process of death with an LVAD, the decisions patients may face at the end of life, and the availability of palliative care or hospice and other support services.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support

Keywords: Confusion, Cardiac Surgical Procedures, Caregivers, Ethics, Heart-Assist Devices, Heart Failure, Hospice Care, Life Change Events, Outcome Assessment (Health Care), Palliative Care


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