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- W2921499655 abstract "Purpose When left ventricular assist device (LVAD) therapy no longer fullfills a patient's desired quality of life, the patient or their surrogate may request withdrawal. However, the details of LVAD withdrawal have not been previously studied. The aim of this study is to describe the factors associated with LVAD withdrawal. Methods Among newly implanted LVADs from 2010 until July 2018 in a single institution, those who underwent withdrawal were included. We divided this cohort into 2 groups based on whether patients initiated the decision of withdrawal (PT+) or patients could not participate due to lack of decision-making capacity (PT-). In PT+, we calculated the days between the patients’ request of withdrawal and deactivation (WD_PT+). In PT-, we calculated the days between the time when patients lost capacity and deactivation (WD_PT-). Multivariate linear regression analyses were done to predict WD_PT-. Place of withdrawal, palliative care involvement, and other clinical factors were also analyzed. Results A total of 61 patients (14 in PT+, 47 in PT-) underwent LVAD withdrawal. Mean age at death was 65.4 ±10.1years and 85.2% were male. Median survival was 170 days. Palliative care was involved in the majority of LVAD withdrawals. Most LVAD withdrawals occurred in the ICU. The median WD_PT was 5.5 days (IQR 39.1), and was shorter in the ICU (n=9, 1 day, IQR 7) than non-ICU settings (n=5, 46 days, IQR 95.5). The median WD_PT- was 5.5 days (IQR 9.3), and was shorter in the ICU (n=42, 4 days, IQR 10) than in non-ICU settings (n=4, 13 days, IQR 32.3). A multivariate analysis showed that male and ICU setting were significantly associated with WD_PT- (p=0.025 for male, p=0.005 for ICU setting) Conclusion The majority of LVAD withdrawals were done in the ICU. Patients’ request of withdrawal was respected sooner and surrogates’ decisions for withdrawal occurred sooner in the ICU. Time to surrogates’ decision for withdrawal was shorter in male patients. Palliative care was involved in the majority of withdrawals." @default.
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- W2921499655 date "2019-04-01" @default.
- W2921499655 modified "2023-10-02" @default.
- W2921499655 title "Difficulty in Dying on LVAD: A Preliminary Analysis of Factors Associated with Time to LVAD Withdrawal" @default.
- W2921499655 doi "https://doi.org/10.1016/j.healun.2019.01.1119" @default.
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