A Call for Guidance in the Use of Left Ventricular Assist Devices in Older Adults

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 60; no. 1; pp. 145 - 150
• Main Authors: Vitale, Caroline A., Chandekar, Rashmi, Rodgers, Phillip E., Pagani, Francis D., Malani, Preeti N.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01-01-2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; destination therapy; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Follow-Up Studies; General aspects; Guideline Adherence; Heart failure; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices - standards; Humans; Intensive care medicine; left ventricular assist devices; Male; Medical equipment; Medical sciences; Miscellaneous; older adults; Older people; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Transplants & implants; Ventricular Function, Left - physiology; Human; Artificial heart; Intensive cardiocirculatory care; destination therapy; Use; Cardiocirculatory support; left ventricular assist devices; Quality of life; Guidance; Gerontology; Treatment; older adults; Elderly; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2011.03740.x

Ethics, Public Policy and Medical Economics
Left ventricular assist devices (LVADs) are approved as “destination therapy” (permanent use without plans for transplantation) in individuals with advanced heart failure who are not candidates for a cardiac transplant; as such, these devices are increasingly being used in older adults. Although LVADs have been shown to increase quality of life and survival, the associated treatment burdens and complications deserve careful consideration. The current study illustrates myriad clinical challenges that can arise during long‐term mechanical support using an older adult case history. Current data on LVAD use in older adults is reviewed, and a discussion of relevant points to consider before LVAD implantation in older adults, including advance care planning, assessment of gait and cognition, and the potential for substantial caregiver burden, is undertaken.