Palliative Care Integration for Patients Receiving Left Ventricular Assist Device as Destination Therapy

Topic: Specific Patient Populations

 

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Left Ventricular Assist Device as Destination Therapy (LVAD-DT) can be life-prolonging therapy available to select patients with advanced heart failure; it is also associated with significant morbidity, mortality and supportive care needs. MedStar Washington Hospital Center began integrating Palliative Care Services for LVAD-DT patients in January 2015. Using the electronic health record, we retrospectively reviewed all LVAD-DT patients who received PC consultation between January and July 15, 2015. Data collected included reason for PC consultation, pain and symptom assessment (day 0, day 2), PC interventions, and disposition. Thirty one LVAD-DT patients received PC consultations .  The primary reason for PC consultation was pain (25/31); median time to consultation was 9 days (median total length of stay was 26 days). Eighty-one percent of patients had moderate-severe symptoms at time of consult, which decreased to 20% by day 2. Additional PC interventions included psychological (19%), spiritual (32%) and/or medication (87%) counseling as well as disease state education (26%), proxy determination (13%) change in code status (3%). Most patients went home (58%) or to rehab (39%) on discharge; 3% died in hospital. We conclude that LVAD-DT candidates experienced notable symptom burden and required multiple PC interventions, highlighting the value of PC integration.

Author

  • Hunter Groninger, MD
  • hunter.groninger@medstar.net
  • MedStar Washington Hospital Center Department of Medicine Section of Palliative Care
  • 110 Irving St NW
  • Washington, DC 20010
  • (703) 343-5859

Co-authors

  • A. Kelemen, LICSW
  • G. Ruiz, MD
  • JT Panke, NP, ACHPN
  • K. Walker, PharmD
  • M. Aggarwal, MD, MPH
  • RM Holder, PharmD

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