Thresholds of physical activity and life expectancy for patients considering destination ventricular assist devices.
BACKGROUND
Current implantable left ventricular assist devices (LVAD) improve survival and function for patients with very late stage heart failure (HF) but may also offer benefit before inotrope dependence. Debate continues about selection of HF patients for LVAD therapy. We sought to determine what level of personal risk and disability HF patients thought would warrant LVAD therapy.


METHODS
The study included 105 patients with symptomatic HF and an LV ejection fraction (EF) < 35% who were given a written paragraph about LVADs and asked about circumstances under which they would consider such a device. New York Heart Association (NYHA) functional class, time trade-off utility, and patient-assessed functional score were determined.


RESULTS
Participants (mean age, 58 years) had an LVEF of 21%. The median duration of HF was 5 years, and 65% had a primary prevention implantable cardioverter defibrillator. Presented with a scenario of bed-ridden HF, 81% stated they would definitely or probably want an LVAD; 50% would consider LVAD to prolong survival if HF survival were predicted to be < 1 year and 75% if < 6 months. Meanwhile, 44% would consider LVAD if they could only walk < 1 block and 64% if they could not dress without stopping. Anticipated thresholds did not differ by NYHA class, time trade-off, or functional score.


CONCLUSIONS
Patient thresholds for LVAD insertion parallel objective survival and functional data. HF patients would be receptive to referral for discussion of LVAD by the time expected mortality is within 6 to 12 months and activity remains limited to less than 1 block.
Stewart
Garrick C
GC
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. gcstewart@partners.org
Brooks
Kimberly
K
Pratibhu
Parakash P
PP
Tsang
Sui W
SW
Semigran
Marc J
MJ
Smith
Colleen M
CM
Saniuk
Catherine
C
Camuso
Janice M
JM
Fang
James C
JC
Mudge
Gilbert H
GH
Couper
Gregory S
GS
Baughman
Kenneth L
KL
Stevenson
Lynne W
LW
D000203:Activities of Daily Living; D001294:Attitude to Health; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000523:psychology; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D013318:Stroke Volume; D017741:Survivors; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*