title: Thresholds of physical activity and life expectancy for patients considering destination ventricular assist devices.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. gcstewart@partners.org
authors.forename: Garrick C
authors.initials: GC
authors.lastname: Stewart
authors.forename: Kimberly
authors.initials: K
authors.lastname: Brooks
authors.forename: Parakash P
authors.initials: PP
authors.lastname: Pratibhu
authors.forename: Sui W
authors.initials: SW
authors.lastname: Tsang
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Smith
authors.forename: Catherine
authors.initials: C
authors.lastname: Saniuk
authors.forename: Janice M
authors.initials: JM
authors.lastname: Camuso
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.forename: Gilbert H
authors.initials: GH
authors.lastname: Mudge
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Baughman
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
mesh_terms: 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*