A Retrospective Review of the Role of Palliative Care in Patients Evaluated for Left Ventricular Device Implantation (QI827)

Abstract

•Identify outcomes of patients undergoing LVAD evaluation.•Identify demographics of population undergoing LVAD evaluation. Left Ventricular Assist Device (LVAD) is a therapy that can prolong life in advanced heart failure patients. This population and their caregivers can have significant physical, emotional, and psychosocial needs. In October 2014, to improve the quality of care for this population, the Joint Commission recommended Palliative Care be added to the core interdisciplinary team. In 2016, North Shore University Hospital (NSUH) started their LVAD program and collaborated with the Geriatrics and Palliative (GAP) Care team to meet this quality measure. Identify needs and outcomes of patients evaluated for LVAD implantation. The LVAD team identified patients with advanced heart failure who may need an LVAD implantation, and GAP team was consulted for such patients as part of the comprehensive evaluation. In a retrospective review, we examined designation of a healthcare proxy, disposition, readmission and length of stay in patients who underwent evaluation for an LVAD but did not receive an implantation. In addition, the multifactorial needs of LVAD patients were identified. Between 2016 and 2017, the LVAD program evaluated 50 patients, of which 20 received an implantation. The NSUH GAP team consulted on 44 of the patients, with 26 of them not receiving an implantation. Of the 26 patients, the average age was 59, 95% male, with English as the primary language. African Americans/ multiracial patients comprised the majority of patients (59%). 63% did not have a healthcare proxy identified. 22.7% of the patients expired in the hospital and 59% had a greater length of stay of more than 15 days. The number of patients who expired highlights the need to explore patients’ and families’ wishes as part of preparedness planning. Given the number of readmissions, close collaboration is needed in the outpatient setting to address complications that may prevent a re-hospitalization.