Abstract 2359: Heart Failure Patients Define Threshold for Left Ventricular Assist Devices
Introduction: Current implantable left ventricular assist devices (LVAD) have been shown to improve survival and function for patients with very late-stage heart failure (HF) but also offer benefit prior to inotrope dependence. As debate continues within the physician community, we sought to determine what level of personal risk and disability would be considered by HF patients to warrant LVAD therapy.
Methods: Patients with symptomatic HF and LVEF <35% in two HF referral programs were given information about implantation, survival, and functional capacity for pulsatile LVAD devices. They were asked about circumstances under which they would consider such a device. NYHA Class on the day of the survey and functional testing within 3 months were recorded.
Results: The 102 patients surveyed had a mean age 58, LVEF 21%, peak VO2 14 ml/kg/min, patient-assessed functional score 59/100, median HF duration 5yrs, and 37% were NYHA Class III. Presented with a scenario of end-stage HF, 81% stated they would definitely or probably want LVAD. To prolong survival, half would consider LVAD if HF life expectancy were predicted to be <1yr, 75% if HF survival <6 mos., and the rest if survival were <1 month. HF patients would tolerate different levels of functional limitation before considering LVAD. [Figure⇓] Current NYHA Class did not influence when patients would want an LVAD in order to prolong life or to be more active.
Conclusion: Patient thresholds for LVAD parallel objective survival and functional data. In HF patients without contraindications, LVAD should be discussed by the time expected mortality is within 6 –12 months and activity is limited to less than one block