Palliative Care Interventions before Left Ventricular Assist Device Implantation in Both Bridge to Transplant and Destination Therapy

Background: The optimal level of palliative care (PC) involvement in left ventricular assist device (LVAD) therapy has yet to be determined. Objective: Describe the feasibility of PC intervention to elucidate patients' goals and values in LVAD therapy in both destination therapy (DT) and bridge to transplant (BTT). Design: Single center, prospective, single-arm study. Setting/Subjects: All patients who received mandatory PC consultation, using a semistructured script, before LVAD implantation (PreVAD evaluation). Measurements: We evaluated the feasibility of PreVAD evaluation and family awareness by analyzing responses and compared it between DT and BTT. We examined the association between withdrawal of LVAD therapy and family awareness in death cases. Results: Between January 2014 and September 2016, 112 patients (DT, 75; BTT, 37) underwent PreVAD evaluation. All patients could express what makes their life meaningful, and 101 (92.0%) could discuss possible complications. Seventy-nine patients (70.5%) could articulate their unacceptable health state. There was no difference between both groups. Family awareness increased significantly from 33.0% to 58.0% after PreVAD evaluation (p < 0.01). Five LVADs were deactivated among the 12 death cases, and they were all from the family-aware group (71.2% vs. 0%, p = 0.027). Conclusions: Integrated PC intervention was feasible for both BTT and DT patients. Such an intervention may increase family awareness of the patient's unique concerns and may have an impact on decision making at the end of life.