TY - JOUR
T1 - Considerations for Referral
T2 - What Happens to Patients After Being Turned Down for Left Ventricular Assist Device Therapy
AU - Yu, Sarah
AU - Cevasco, Marisa
AU - Sanchez, Joseph
AU - Ruan, Diana
AU - Pineda, Marie Finelle
AU - Ross, Katherine
AU - Nakagawa, Shunichi
AU - Yuzefpolskaya, Melana
AU - Farr, Maryjane A.
AU - Colombo, Paolo C.
AU - Takayama, Hiroo
AU - Naka, Yoshifumi
AU - Takeda, Koji
N1 - Publisher Copyright:
© 2019
PY - 2020/4
Y1 - 2020/4
N2 - Background: Left ventricular assist device (LVAD) therapy has revolutionized the treatment options for patients with advanced heart failure. Patient selection is essential for obtaining successful results. However, few data exist concerning the outcomes of patients evaluated for LVAD therapy but subsequently rejected or deferred. Methods and Results: This is a retrospective review of all patients referred for LVAD therapy at our institution between January 2009 and December 2016. Baseline demographics and Interagency Registry for Mechanically Assisted Circulatory Support profiles were collected, and reasons for rejection or deferral for LVAD placement were investigated. A total of 669 patients were referred for LVAD therapy, and 228 patients (34%) were turned down. The yearly acceptance rate ranged between 57% and 75%. The average age of the turned-down cohort was 60.8 ± 12.5 years; 83% were men. Reasons for rejection included: patient being too sick (34%); psychosocial concerns (25%); patient declined (16%); decision was deferred for medical optimization (15%); or patient being too well (10%). The percentage of patients who were rejected due to psychosocial concerns has increased over time (P = 0.02), whereas the rate of deferral for medical optimization has remained stable (P = 0.10). One-year survival after initial LVAD consultation was 42% in those who were too sick, 64% in those with psychosocial concerns, 68% in patients who declined, 86% in those deferred for medical optimization; and 100% in those too well (P < 0.01). Conclusions: One-year survival is reduced among patients who were initially turned down for LVAD therapy, except for those in whom this decision was deferred for medical optimization or because the patient was too well. Psychosocial concerns have become a significant barrier to LVAD therapy.
AB - Background: Left ventricular assist device (LVAD) therapy has revolutionized the treatment options for patients with advanced heart failure. Patient selection is essential for obtaining successful results. However, few data exist concerning the outcomes of patients evaluated for LVAD therapy but subsequently rejected or deferred. Methods and Results: This is a retrospective review of all patients referred for LVAD therapy at our institution between January 2009 and December 2016. Baseline demographics and Interagency Registry for Mechanically Assisted Circulatory Support profiles were collected, and reasons for rejection or deferral for LVAD placement were investigated. A total of 669 patients were referred for LVAD therapy, and 228 patients (34%) were turned down. The yearly acceptance rate ranged between 57% and 75%. The average age of the turned-down cohort was 60.8 ± 12.5 years; 83% were men. Reasons for rejection included: patient being too sick (34%); psychosocial concerns (25%); patient declined (16%); decision was deferred for medical optimization (15%); or patient being too well (10%). The percentage of patients who were rejected due to psychosocial concerns has increased over time (P = 0.02), whereas the rate of deferral for medical optimization has remained stable (P = 0.10). One-year survival after initial LVAD consultation was 42% in those who were too sick, 64% in those with psychosocial concerns, 68% in patients who declined, 86% in those deferred for medical optimization; and 100% in those too well (P < 0.01). Conclusions: One-year survival is reduced among patients who were initially turned down for LVAD therapy, except for those in whom this decision was deferred for medical optimization or because the patient was too well. Psychosocial concerns have become a significant barrier to LVAD therapy.
KW - LVAD outcomes
KW - patient selection
KW - turned down for LVAD therapy
UR - http://www.scopus.com/inward/record.url?scp=85076559502&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076559502&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2019.10.009
DO - 10.1016/j.cardfail.2019.10.009
M3 - Article
C2 - 31672621
AN - SCOPUS:85076559502
SN - 1071-9164
VL - 26
SP - 300
EP - 307
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 4
ER -