Abstract 4143888: Exploring the Perspectives and Journey of Patients Utilizing Left Ventricular Assist Devices as They Approach End-of-Life: A Cross-sectional Study

Background: Over the past decade over 27,000 patients have been implanted with a left ventricular assist device (LVAD) for the treatment of advanced heart failure (HF). Technology has advanced greatly over this time with 1-year mortality rates around 14% for the newer devices. Up to 75% of the HF population is thought to have mild cognitive impairment, which is related to increased readmission rates and higher mortality. Guidelines provided by professional organizations encourage providers to discuss end-of-life situations with LVAD patients and their caregivers. Purpose: The purpose of this study was to explore the attitudes and experiences of patients with an LVAD related to end-of-life situations and pump exchanges, and to identify if mild cognitive impairment impacts end-of-life decision-making. Methods: A cross-sectional, correlational study design was used, with 30 LVAD patients completing an end-of-life questionnaire and a validated cognitive assessment instrument. Results: The average age of the participants was 57±16, 77% male, 90% identified as white, non-Hispanic, and 63% were labeled as destination therapy. Fifty-eight percent of the cohort had discussed end-of-life scenarios with a healthcare provider, and 60% had discussed what a pump exchange involved. Forty-four percent of the total cohort indicated they never wanted to have a conversation about end-of-life with their provider and 73% said they would have a pump exchange even if they were seriously ill and were dying of a terminal illness other than heart failure. Of the 29 patients who were able to complete the cognitive assessment, 79% met criteria for mild cognitive impairment. There were no differences in the experiences and attitudes regarding end-of-life between those with mild cognitive impairment, and those with normal cognition. Conclusion: Despite having higher mortality rates in the HF population, those with mild cognitive impairment had similar experiences and attitudes regarding end-of-life. There are still many misconceptions regarding decision-making related to the end-of-life and pump exchange for patients with an LVAD, and moving forward it is important to identify factors that may influence these decision-making processes.