Describing the End of Life Experience of Patients Supported with a Life-Sustaining Left Ventricular Assist Device (LVAD) as Bridge to Transplantation in a UK Centre
| Autor: | D. Weiand, Maria McKenna |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Advance care planning Heart transplantation Transplantation medicine.medical_specialty Palliative care business.industry medicine.medical_treatment Sudden death Ventricular assist device Emergency medicine Cohort Medicine Surgery Cardiology and Cardiovascular Medicine business End-of-life care |
| Zdroj: | The Journal of Heart and Lung Transplantation. 38:S302 |
| ISSN: | 1053-2498 |
| Popis: | Purpose In the UK, patients with severe heart failure suitable for heart transplantation may be managed with a life-sustaining LVAD as a bridge to transplant. Many will not undergo transplantation, either due to lack of donor organs or clinical deterioration rendering them no longer fit for surgery. These patients are at risk of LVAD-related complications and will die with their device in situ. The UK healthcare system and palliative care provision differs significantly with the US. We describe the end of life for this UK patient group. Methods Retrospective case note review of 40 deceased patients who underwent LVAD implantation between 2010 and 2016 at a single UK centre. Results Within this cohort, mean age at death was 57 years, with median interval between LVAD implantation and death of 18 months (range 6-76). This group were geographically diverse, only 12.5% lived close to the specialist centre. In 40% of cases, some advance care planning had been commenced, with a ‘Do Not Attempt Cardio Pulmonary Resuscitation’ decision documented. This cohort included no cases of elective LVAD deactivation; instead the LVAD was deactivated at the point of natural death. 45% received palliative care review (n=18). Death was described as sudden in 17 patients; this subgroup most commonly died at home (65%). Where dying was recognised and death expected (n=19), patients were highly likely to die in hospital (84%), but transfer to a local hospital close to home (5%) or a hospice (16%) was achieved for a minority. Overall, preferred place of death was documented for 12 patients and achieved in 10/12 cases. Challenges around practical management of the life-sustaining LVAD in the last hours of life, resulted in no expected deaths at home. Anticipatory SC PRN medications were prescribed for 68% and symptom assessment undertaken in 84% of cases. Conclusion The last days of life for patients in the UK with LVAD support, were commonly spent in hospital following active management of a LVAD-related complication. This is comparable with recent US data. There is scope for further improvement in recognition of dying and advance care planning given the possibility of sudden death. Early and routine palliative care input is recommended to improve quality of end of life care, including consideration of future care wishes and practical device management. |
| Databáze: | OpenAIRE |
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