Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Sep 23;23(1):229.
doi: 10.1186/s12904-024-01563-8.

Multicenter exploration of specialist palliative care in patients with left ventricular assist devices - a retrospective study

Theresa Tenge  1   2 , Shaylin Shahinzad  2 , Stefan Meier  1 , Manuela Schallenburger  2 , Yann-Nicolas Batzler  2 , Jacqueline Schwartz  3 , Anja Coym  4 , Johannes Rosenbruch  5 , Mitra Tewes  6 , Steffen T Simon  7 , Carmen Roch  8 , Ute Hiby  9 , Christian Jung  10 , Udo Boeken  11 , Jan Gaertner  12   13 , Martin Neukirchen  1   2
Affiliations
Multicenter Study

Multicenter exploration of specialist palliative care in patients with left ventricular assist devices - a retrospective study

Theresa Tenge et al. BMC Palliat Care. .

Abstract

Background: The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients.

Methods: We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included.

Results: In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3-50.3 months). Median duration between consultation and death was seven days (IQR 3-28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p < 0.001; DNR before: n = 20, after: n = 28, p < 0.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3-6); first contact: median 9 (IQR 6-10); p < 0.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit.

Conclusions: This largest European multicenter investigation of LVAD-patients receiving specialist palliative care shows a late integration and high physical and psychosocial symptom burden. This study highlights the urgent need for earlier integration to identify and address poorly controlled symptoms. Further studies and educational efforts are needed to close the gap between guideline-recommendations and the current status quo.

Keywords: Heart failure; Heart-assist devices; Multicenter study; Palliative medicine; Quality of life; Retrospective studies.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Time demonstrations. Duration from left ventricular assist device (LVAD) implantation to first specialist palliative care contact and duration from first contact to death in days. Patients are displayed in order of the duration of LVAD implantation to first specialist palliative care contact for visualization purposes
Fig. 2
Fig. 2
Symptom burden symptom intensities. Radar plot presenting the number of patients with each symptom documented in the consultation requests and in the notes from the first palliative care contact. * indicates a significant difference
Fig. 3
Fig. 3
Symptom intensities. Heat map showing the intensity of the symptoms assessed at first specialist palliative care contact. Only patients with documented data are presented. ADLs, Activities of Daily Life
See this image and copyright information in PMC

References

    1. Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118:3272–87. - PubMed
    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failureDeveloped by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42:3599–726. - PubMed
    1. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145:E876–94. - PubMed
    1. Molina EJ, Shah P, Kiernan MS, Cornwell WK, Copeland H, Takeda K, et al. The Society of Thoracic Surgeons Intermacs 2020 Annual Report. Ann Thorac Surg. 2021;111:778–92. - PubMed
    1. Rao A, Violanti D, Elliott TI, Singh M, Kim B, VandenAssem K, et al. Clinical Protocol for Left Ventricular Assist Device Deactivation at End of Life. J Palliat Med. 2023;26:1428–34. - PubMed

Publication types

LinkOut - more resources