• Shunichi Nakagawa, Masahiko Ando, Hiroo Takayama, Koji Takeda, Arthur R Garan, Lauren Yuill, Amanda Rosen, Veli K Topkara, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, and Craig D Blinderman.
• Adult Palliative Care, Department of Medicine, Columbia University Medical Center, New York, New York.
• J Palliat Med. 2020 Mar 1; 23 (3): 368-374.

AbstractBackground: When left ventricular assist device (LVAD) therapy no longer is able to achieve patients' desired quality of life, withdrawal of LVAD therapy (WLVAD) may be requested. Objectives: To evaluate factors associated with WLVAD, including the time taken before WLVAD. Setting/Subjects: Sixty-two patients who newly underwent initial LVAD therapy during January 1, 2010 and October 30, 2018 and subsequently underwent WLVAD by December 31, 2018 were divided into those who participated in the decision of WLVAD (defined as PT+, n = 14), and those who could not participate in the decision because of the medical reasons (defined as PT-, n = 48). Measurements: Time to WLVAD in PT+ and PT- was defined as WD_PT+ (days between patients' request and WLVAD) and WD_PT- (days between when patients became unable to express themselves and WLVAD), respectively. Circumstances around WLVAD, including location of death and use of palliative care (PC), were reviewed. Results: Mean age at WLVAD was 65.4 ± 10.1 years and 52 (83.9%) were men. Median days on LVAD support was 166.5 days (interquartile range = 838). The majority of WLVAD occurred in the intensive care unit (ICU) (83.6%) but less frequent in PT+ than in PT- (64.3% vs. 89.4%, p = 0.041). The median number of PC visits in the last month was higher in PT+ than in PT- (4.5 vs. 0.5, p = 0.005). The median WD_PT+ was 5.5 days and was significantly shorter in the ICU (1 day vs. 46 days, p = 0.013). The median WD_PT- was 5.5 days and tended to be shorter in the ICU (4 days vs. 13 days, p = 0.072). A multivariate analysis showed that male gender and ICU setting were both negatively associated with WD_PT- (p = 0.025 for men, p = 0.005 for ICU setting). Conclusions: The majority of WLVAD occurred in the ICU and required PC involvement. Time to WLVAD was shorter in the ICU. Requests for WLVAD directly made by patients, especially in a non-ICU setting, seemed to have posed more difficulty.

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