title: A call for guidance in the use of left ventricular assist devices in older adults.
abstract: Left ventricular assist devices (LVADs) are approved as "destination therapy" (permanent use without plans for transplantation) in individuals with advanced heart failure who are not candidates for a cardiac transplant; as such, these devices are increasingly being used in older adults. Although LVADs have been shown to increase quality of life and survival, the associated treatment burdens and complications deserve careful consideration. The current study illustrates myriad clinical challenges that can arise during long-term mechanical support using an older adult case history. Current data on LVAD use in older adults is reviewed, and a discussion of relevant points to consider before LVAD implantation in older adults, including advance care planning, assessment of gait and cognition, and the potential for substantial caregiver burden, is undertaken.
authors.affiliation: Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Geriatric Research, Education and Clinical Center, VeteransAffairs Ann Arbor Healthcare System, 2215 Fuller Road, GRECC (11G), Ann Arbor, MI 48105, USA. cavitale@umich.edu
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Vitale
authors.forename: Rashmi
authors.initials: R
authors.lastname: Chandekar
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Rodgers
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000592:standards*; D006801:Humans; D008297:Male; D011788:Quality of Life; D016277:Ventricular Function, Left / Q000502:physiology*