Current Heart Failure Reports

, 8:212

Palliative Care and End-of-Life Issues in Patients Treated with Left Ventricular Assist Devices as Destination Therapy

  • Keith M. Swetz
  • Abigale L. Ottenberg
  • Monica R. Freeman
  • Paul S. Mueller


Left ventricular assist devices as destination therapy (DT) improve quality of life for many patients with advanced heart failure. However, DT can be associated with risks such as infection, bleeding, and stroke, and may impose psychosocial strain on patients and caregivers. Furthermore, patients treated with DT eventually will die with their device in place whether death is related to the device or not. In response to these concerns, palliative medicine consultation has been suggested with standard DT care to improve focus on quality of life, symptom management, and end-of-life planning. This article reviews key issues associated with caring for patients with DT, including psychosocial, quality-of-life, caregiving, and ethical issues, and discusses end-of-life management of patients with DT, including practical considerations, but moreover, review topics regarding communication, symptom management, and provision of appropriate comfort care.


Ventricular assist device LVAD Quality of life Quality of care Heart failure End-stage heart failure ESHF Destination therapy DT Advance care planning Preparedness planning Palliative care End of life Medical ethics Patient-caregiver communication Psychosocial issues 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Keith M. Swetz
    • 1
  • Abigale L. Ottenberg
    • 1
  • Monica R. Freeman
    • 1
  • Paul S. Mueller
    • 1
  1. 1.Division of General Internal MedicineMayo ClinicRochesterUSA

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