• Shunichi Nakagawa, Hiroo Takayama, Koji Takeda, Veli K Topkara, Lauren Yuill, Suzanne Zampetti, Katherine McLaughlin, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, Nir Uriel, and Craig D Blinderman.
• Department of Medicine, Adult Palliative Care Service, Columbia University Irving Medical Center, New York, New York, USA. Electronic address: sn2573@cumc.columbia.edu.
• J Pain Symptom Manage. 2020 Nov 1; 60 (5): 976-983.e1.

ContextPalliative care consultation before left ventricular assist device (LVAD) surgery (PreVAD) has been recommended, but its impact on goal-concordant care is unknown.ObjectivesTo describe the association between patients' unique unacceptable condition articulated during PreVAD with the actual care provided at the end of life.MethodsAmong 308 patients who had PreVAD between 2014 and 2019, 72 patients died before December 31, 2019. Based on the answers to the question, "Is there any condition you would find unacceptable?" patients were divided into ARTICULATE (those who could articulate their unacceptable condition clearly, n = 58) and non-ARTICULATE (those who could not, n = 14). Circumstances at death and end-of-life care were compared between groups.ResultsMean age at death was 63.2 years (SD ±13.1), 56 patients (77.8%) were males, and median duration of LVAD was 167.5 days (interquartile range 682). ARTICULATE patients died less frequently in the intensive care unit than non-ARTICULATE patients (33 patients, 57.9% vs. 13 patients, 92.9%; P = 0.014) and had ethics consultation less frequently (four patients, 6.9% vs. five patients, 35.7%; P = 0.011). Frequency of LVAD withdrawal was similar in both groups. Among ARTICULATE cohort, the unacceptable condition articulated in PreVAD did not seem to influence decisions at the end of life.ConclusionPatients who articulated their unacceptable condition clearly before LVAD surgery had less frequent ethics consultations and received less intensive care at the end of life, but it did not seem to affect the decision of LVAD withdrawal. It may be more important to engage in discussions around their unacceptable conditions, rather than the specific condition articulated. The question of an unacceptable condition should be part of any routine palliative care consultation before LVAD surgery.Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

15 keywords...

hide…