Extraordinary Devices, Exquisite Care: Palliative Care Assessment and Management of Patients With Ventricular Assist Devices (308): Heart Failure SIG

Abstract

1.Discuss a general overview of ventricular assist devices and the associated benefits/burdens, morbidity, and mortality.2.Describe the role of the palliative care consultant in shared decision making and informed consent during the decision process; and explore the importance of advance care planning with patient and surrogate(s).3.Review key components of the process of implantable cardiac support device deactivation, to promote successful outcomes and appropriate support in this setting. Cardiovascular disease is the leading cause of death in the world. To this end, ventricular assist devices (VADs) have been developed to promote improved quality of life, as well as improved survival in patients who are or are not eligible for transplantation. As VAD availability and implantation rates increase for patients with advanced heart failure, palliative care (PC) and hospice providers will need to keep pace with developments regarding this therapy to optimize patient-centered outcomes. In this session, we will review selection criteria for VAD implantation, with particular attention to recommendations for PC consultant involvement in this process. The role of the PC consultant evolves as a patient proceeds through the stages of device evaluation, shared decision-making, post-implantation care planning and management, and finally end-of-life care including device deactivation. We will review key fundamentals for performing a palliative care assessment in this patient population, including the indications, applications, benefits/risks, and management of VADs. The unique features, risk profiles, frequently-encountered complications, and symptom management issues in this population will be reviewed. We will further review prognostication for these complex patients, and how to successfully plan and execute device deactivation when the VAD is no longer consistent with the patient's goals of care. In order to accomplish optimal VAD deactivation, factors including care setting, presence of other life support devices, and patient/surrogate(s) preferences must be considered. The contributions that PC can bring to the processes of informed consent, shared decision making, and advance care planning will be discussed.