(941) - Integration of Palliative Care in End of Life Care for Patients on Durable Mechanical Circulatory Support

Abstract

Although outcomes for patients on durable ventricular assist device therapy (VAD) continue to improve, patients are still plagued with frequent hospitalizations and limited long-term survival. Little data exists on the optimal timing of and setting for palliative care involvement for these patients. We conducted a retrospective chart review of our single center’s experience to understand how and where VAD patients die. Charts for all patients who died after receiving a durable VAD between August 2008 and January 2015 were reviewed. Only patients who survived index hospitalization and subsequently died on VAD support were included for analysis. Data on demographic, VAD implant data, medical complications, and palliative care utilization were abstracted retrospectively. A total of 62 patients died following VAD implant for either bridge to transplantation (BTT) (49 (79%)) or destination therapy (DT) (13(21%)). Of those, 37 (60%) patients died during the index hospitalization and 25 (40%) patients survived the index hospitalization but ultimately died on VAD support (BTT 66%, DT 34%). Their mean age at time of implant was 59.0 (SD 11.6) years and 84% were male. These patients lived an average of 15.6 (SD 12.4) months on VAD support. Inpatient palliative care team consultation occurred for 12 (48%) of patients at an average of 23.6 (SD 65.3) days prior to death. Causes of death were identified as intracranial bleeding (8 (32%)); pump complications (5 (20%)); sepsis (4 (16%)); multi-organ system failure (3 (12%)), respiratory failure (2 (8%)) and unknown (3 (12%)). Deaths were thought to be sudden, or unexpected, in 14 (56%) patients. Sixteen (64%) patients died in the hospital, 5 (20%) died at home and 4 (16%) died in inpatient hospice. The majority of VAD patients die in hospital settings, but many die at home, and die suddenly. Although palliative care consultation occurred in nearly half of these patients with durable VAD, palliative care was consulted months after VAD implant and near the end of life. There is ongoing need for earlier involvement of palliative care for this population, particularly in the outpatient setting, as a way to improve advanced care planning, symptom management, alignment of treatment preferences with treatments received, as well as caregiver bereavement.