title: Deactivation of Left Ventricular Assist Devices: Differing Perspectives of Cardiology and Hospice/Palliative Medicine Clinicians.
abstract: BACKGROUND
  Beliefs around deactivation of a left ventricular assist device (LVAD) vary substantially among clinicians, institutions, and patients. Therefore, we sought to understand perspectives regarding LVAD deactivation among cardiology and hospice/palliative medicine (HPM) clinicians.
  
  
  RESULTS
  We administered a 41-item survey via electronic mail to members of 3 cardiology and 1 HPM professional societies. A convergent parallel mixed-methods design was used. From October through November 2011, 7168 individuals were sent the survey and 440 responded. Three domains emerged: (1) LVAD as a life-sustaining therapy; (2) complexities of the process of LVAD deactivation; and (3) legal and ethical considerations of LVAD deactivation. Most respondents (cardiology 92%; HPM 81%; P = .15) believed that an LVAD is a life-sustaining treatment for patients with advanced heart failure; however, 60% of cardiology vs 2% of HPM clinicians believed a patient should be imminently dying to deactivate an LVAD (P < .001). Additionally, 87% of cardiology vs 100% of HPM clinicians believed the cause of death following LVAD deactivation was from underlying disease (P < .001), with 13% of cardiology clinicians considering it to be a form of euthanasia or physician-assisted suicide.
  
  
  CONCLUSIONS
  Cardiology and HPM clinicians have differing perspectives regarding LVAD deactivation. Bridging the gaps and engaging in dialog between these 2 specialties is a critical first step in creating a more cohesive approach to care for LVAD patients.
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: colleen.mcilvennan@ucdenver.edu.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: McIlvennan
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Palliative Medicine, Mayo Clinic, Phoenix, Arizona.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Wordingham
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.affiliation: University of Colorado College of Nursing, Aurora, Colorado.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: Department of Cardiovascular Diseases and Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002309:Cardiology / Q000379:methods / Q000639:trends*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006353:Heart-Assist Devices / Q000639:trends*; D017051:Hospice Care / Q000639:trends*; D006738:Hospices / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D065126:Palliative Medicine / Q000379:methods / Q000639:trends*; D010820:Physicians / Q000523:psychology / Q000639:trends*; D011795:Surveys and Questionnaires
keywords: Heart-assist devices; end of life care; heart failure; palliative care