Abstract 4147316: Utilization of Palliative Care for Patients Living with Long-Term (LT) LVAD Therapy

Background: Outpatient palliative care has been associated with improved health-related quality-of-life (HRQoL) in patients with heart failure. However, there is limited understanding of its utilization among patients with long-term left ventricular assist device (LT-LVAD) therapy. The prevalence of LVAD implantation as long-term therapy has increased over the past decade; these patients may particularly benefit from outpatient palliative care. Objective: To identify the predictors of outpatient palliative care utilization in a sample of LT-LVAD patients from a high-volume LVAD center. Methods: This retrospective chart review analyzed data from 270 patients who received LVAD as long-term therapy between January 1, 2017, and December 30, 2021, and were supported on LVAD therapy for at least two years. Patients who received heart transplantation prior to the study end-date were excluded. Logistic regression models were used to estimate the odds of receiving outpatient palliative care (with or without inpatient palliative care) versus receiving inpatient palliative care alone. Results: Among 270 patients, the mean age was 62 years (+/- 12), 74.2% were male, 79.0% Black and 17.3% White. By device: 77.4% received HeartMate 3™ (HM3), 19.6% HVAD™ LVAD, 3.0% HeartMate II™. Patients lived an average of 4 years (+/- 1) post-implantation. The mean number of hospitalizations from implantation to death or end-of-study was 7.85 (+/- 7.04). 180 patients received inpatient palliative care consultation alone; 90 patients received at least one outpatient palliative care visit. Black patients had increased odds of receiving outpatient palliative care compared to White patients (OR 2.27, P=0.040). For each additional hospitalization a patient experienced, the odds of receiving outpatient palliative care increased (OR 1.06, P=0.002). Patients with HVAD™ LVAD were less likely to receive outpatient palliative care than those with HM3 (OR 0.45, P=0.029). Conclusion: In this large cohort of patients supported on LT-LVAD therapy, Black patients were more likely to receive outpatient palliative care than White patients. More frequent hospitalizations and LVAD type were associated with an increased likelihood of outpatient palliative care visits. Future studies should explore the factors contributing to these differences to better understand and enhance palliative care utilization for all patients on LT-LVAD therapy.