Coping With a New Lease on Life after LVAD-DT Implantation: Value of Social Work and Palliative Care in the Pre-LVAD Assessment and Post-Implantation Care

Abstract

Introduction: Left ventricular assist device as destination therapy (LVAD-DT) is a treatment option for patients with advanced heart failure who are not cardiac transplant candidates. While increasingly available, patients, families and some healthcare providers underestimate the substantial care obligations and psychosocial implications associated with this therapy. Hypothesis: By incorporating social work and palliative care in the pre-implantation and post-operative management of LVAD-DT patients, we anticipated improved patient selection leading to better outcomes and early identification of possible obstacles to successful aftercare. Methods: Retrospective chart review of 19 patients who underwent LVAD-DT implantation from January 2009-January 2010. Intervention included social work assessment and proactive palliative care consultation for assistance with preparedness planning. This involved 1) facilitated pre-implantation informed consent, 2) psychosocial evaluation for appropriate candidacy, 3) development of detailed caregiver plans, 4) identification of quality-of-life issues, and 5) optimization of patients' coping skills. Moreover, strategies to address major LVAD-associated adverse events were discussed, including the importance of drafting a detailed advance directive. Results: All patients (19/19) underwent psychosocial assessment. 68% (13/19) received proactive palliative care consultation compared to 0% (0/36) of previous LVAD-DT patients (P < 0.001). Advance directive completion increased to 68% (13/19), compared to 39% (14/36) of previous LVAD-DT patients (P = 0.049). Patient-reported outcomes improved with committed/competent caregivers with good mental and physical health, as these persons were more prepared to meet care needs after implantation. Conclusion: Comprehensive psychosocial and palliative care assessment in the preoperative period is beneficial for optimizing patient selection and communicating informed consent prior to LVAD-DT. This approach can improve patient and caregiver quality-of-life and identify psychological, social, and financial issues earlier. Advanced care planning, including completion of advance directives, has significantly improved. Enhanced training for medical professionals in the patient's receiving community also contributed to successful outcomes. Detailed plans focused on issues of follow-up care, quality-of-life, and potential adverse events after LVAD-DT helps patients to better cope with “their new lease on life.”