title: Reasons for, and outcomes of patients who were referred for a ventricular assist device but were declined: the recent era forgotten ones.
abstract: BACKGROUND
  Ventricular assist devices (VADs) have a proven survival benefit in select patients with advanced heart failure, yet many patients considered for implantation are declined for various reasons. The outcome of these patients is obscure owing to their exclusion from recent VAD studies. We aim to compare the outcomes of patients who received a VAD to those who did not.
  
  
  METHODS
  For this study, the Artificial Heart Program's database at Intermountain Medical Center was queried from 2006 to 2012 for patients referred for a VAD. Kaplan-Meier survival analysis was performed with log-rank test determining significance.
  
  
  RESULTS
  Of 232 patients included, 118 patients received a VAD and 114 patients did not. The prevailing reason for VAD decline in eligible and willing patients was due to pre-existing illness (39%). Mortality was higher in non-VAD vs. VAD patients (58.8% vs. 35.6%, p < 0.001) with a median time-to-death of 67 (IQR:12-314) and 301 (IQR:136-694) d, respectively (p = 0.007).
  
  
  CONCLUSIONS
  In the current era of non-pulsatile VADs, mortality of patients who are considered but not implanted remains high. Additionally, mortality of these patients occurred much sooner. Educational efforts ensuring timely referral for VAD therapy are important to maximize the number of patients who may benefit.
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Johnson
authors.affiliation: University of Utah, Salt Lake City, UT, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: McCandless
authors.affiliation: Cardiology, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Caine
authors.affiliation: Cardiology, Intermountain Medical Center, Salt Lake City, UT, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Budge
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: G Andrew
authors.initials: GA
authors.lastname: Wright
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Asad
authors.initials: A
authors.lastname: Rauf
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Miller
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Sandi
authors.initials: S
authors.lastname: Stoker
authors.affiliation: Intermountain Heart Institute, Heart Failure & Transplant, Salt Lake City, UT, USA.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Smith
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Kia
authors.initials: K
authors.lastname: Afshar
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Reid
authors.affiliation: Intermountain Medical Center, Mechanical Circulatory Support, Utah Artificial Heart Program, Murray, UT, USA.
authors.forename: Brad Y
authors.initials: BY
authors.lastname: Rasmusson
authors.affiliation: Intermountain Heart Institute, Heart Failure & Transplant, Salt Lake City, UT, USA.
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
mesh_terms: D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome
keywords: mechanical circulatory support; outcomes; referred; survival; ventricular assist device