“Would You Get A Destination Therapy Left Ventricular Assist Device?”: Health Care Providers Describe A Preference-sensitive Decision

Abstract

Background In patients with advanced heart failure who are not transplant candidates, destination therapy left ventricular assist devices (DT-LVAD) are a potential life-prolonging treatment option, but also come with risks and burdens, creating a complex medical decision. Health care providers who care for these patients have exposure to a range of outcomes with DT-LVAD, and thus may provide perspective into the nature of this decision. Methods As part of the I-DECIDE-LVAD dissemination and implementation project, we surveyed clinical team members of mechanical circulatory support programs. The survey was distributed by cardiology professional societies and listservs over email in April 2019. The survey had 47 items, including a hypothetical question, “Personally, would you get a DT-LVAD If you had end-stage heart failure and were not eligible for transplant?” We collected personal and institutional characteristics of respondents and analyzed the data using chi squared tests and multivariate analyses. Results Responses were received from 530 healthcare providers, and 470 of those replied to the primary hypothetical question for this analysis. Respondents were 78.2% female, 18.7% male, and 2.6% did not respond; 12.8% physicians, 23.2% advanced practice providers, 41.6% registered nurses, 11.6% social workers, 8.5% other providers, and 2.4% did not respond. To the question of whether they would personally get a DT LVAD, 55 (10.4%) responded definitely, 231 (43.6%) responded probably, 149 (28.1%) responded probably not, 35 (6.6%) responded definitely not, and 60 (11.3%) did not respond. Men were more likely to respond affirmatively to the question than women (p = 0.0251). There was no association between responses to personally getting an LVAD and age, years working with LVAD patients, or role in the program. In analysis of programmatic factors, working at a heart transplant center was associated with affirmative responses to the question. There was not an association between response to personally getting an LVAD and type of institution (university, community based, or federally funded), volume of LVADs, or region of the country. Conclusion The majority of healthcare providers with direct exposure to LVADs express some ambivalence towards the therapy, emphasizing the dependence of this complex decision on personal preference and context. In patients with advanced heart failure who are not transplant candidates, destination therapy left ventricular assist devices (DT-LVAD) are a potential life-prolonging treatment option, but also come with risks and burdens, creating a complex medical decision. Health care providers who care for these patients have exposure to a range of outcomes with DT-LVAD, and thus may provide perspective into the nature of this decision. As part of the I-DECIDE-LVAD dissemination and implementation project, we surveyed clinical team members of mechanical circulatory support programs. The survey was distributed by cardiology professional societies and listservs over email in April 2019. The survey had 47 items, including a hypothetical question, “Personally, would you get a DT-LVAD If you had end-stage heart failure and were not eligible for transplant?” We collected personal and institutional characteristics of respondents and analyzed the data using chi squared tests and multivariate analyses. Responses were received from 530 healthcare providers, and 470 of those replied to the primary hypothetical question for this analysis. Respondents were 78.2% female, 18.7% male, and 2.6% did not respond; 12.8% physicians, 23.2% advanced practice providers, 41.6% registered nurses, 11.6% social workers, 8.5% other providers, and 2.4% did not respond. To the question of whether they would personally get a DT LVAD, 55 (10.4%) responded definitely, 231 (43.6%) responded probably, 149 (28.1%) responded probably not, 35 (6.6%) responded definitely not, and 60 (11.3%) did not respond. Men were more likely to respond affirmatively to the question than women (p = 0.0251). There was no association between responses to personally getting an LVAD and age, years working with LVAD patients, or role in the program. In analysis of programmatic factors, working at a heart transplant center was associated with affirmative responses to the question. There was not an association between response to personally getting an LVAD and type of institution (university, community based, or federally funded), volume of LVADs, or region of the country. The majority of healthcare providers with direct exposure to LVADs express some ambivalence towards the therapy, emphasizing the dependence of this complex decision on personal preference and context.