Education and Decision-Making in Patients and Caregivers Considering Left Ventricular Assist Devices

Abstract

Purpose Left ventricular assist device (LVAD) is a mainstay of therapy in end-stage heart failure, but presents a challenge in decision-making to patients and caregivers. The aim of this study is to assess patient education and understanding of LVAD therapy. Methods Consecutive candidates for LVAD therapy were enrolled for this study. Patients were excluded if they were unable to participate in baseline testing. Prior to LVAD implant, health literacy was assessed by Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) testing, a word-recognition test of 11 items. Cognitive function was assessed by St. Louis University Mental Status Exam (SLUMS), a brief oral and written exam. LVAD knowledge was assessed by a validated 20-item score. Results 21 patients were enrolled. The median age was 59 years and 62% of the patients were male. Most patients were institution naive, and only 47% had a documented prior advanced heart failure (HF) clinic visit. The majority of patients were on IV inotropes (85.7%) at the time of evaluation and many had indwelling aortic balloon pumps (42.9%). The median time to assessment following formal LVAD education was 1 day. 31% of patients had low health literacy based on REALM-R testing. Median SLUMS scores were in range of mild neurocognitive disorder (22.5; IQR 21, 25) (Fig. 1A). Baseline knowledge check demonstrated a low median score (45/100; IQR 35, 50) (Fig. 1B), and no patient reached a score of >70 (previously described average). Conclusion The majority of referrals for LVAD at our institution are late referrals of critically ill patients. Health literacy and cognitive scores are low in our patient population resulting in low knowledge check scores, despite systematic LVAD education. Patient specific LVAD education should address each patient's individual needs.