Patients with a Left Ventricular Assist Device: the new chronic patient in cardiology

Abstract

In earlier days patients died from the plague or smallpox. Acute epidemic infectious diseases with high mortality rates were feared everywhere and medical care was mainly oriented towards relieving symptoms by means of anecdotal therapies. Understanding the causes of many diseases and improved preventive medicine has reduced the incidence and severity of some, but unfortunately the cure for most diseases has not yet been found. 1,2 As with general medicine, cardiology also faced many changes in the incidence and severity of cardiac diseases. For example, the incidence of rheumatic heart diseases has dropped largely in industrialized countries and the survival rate from acute coronary events has significantly improved. 3,4 Even the feared exponential increase in the number of heart failure patients has recently been shown to be better controlled with the introduction of evidencebased preventive measures and medical therapies. 5,6 In 2012, we live in a time where not only have we left ‘old’ diseases behind, but are instead facing a variety of patient groups with ‘new diseases’. For example, patients who learn to live with a chronic disease or patients who are treated with advanced therapies such as kidney replacement therapies (hemodialysis or peritoneal dialysis), or patients who undergo an organ transplantation. One relatively new group of chronic patients to consider in cardiac care is the group of patients with a Left Ventricular Assist Device (LVAD). The increasing number of end-stage heart failure patients, some of whom are ineligible for heart transplantation, and the limited number of heart donors has increased the number of LVAD patients. Among them, there is a particular increase in the percentage of patients who are not bridged to heart transplantation but are intended to be permanently supported (destination therapy). 7 With the