Get access

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

Authors

  • Caroline A. Vitale MD,

    Corresponding author
    1. Section of Cardiac Surgery, Department of Surgery, University of Michigan Health System
    • Division of Geriatric Medicine, University of Michigan Health System
    Search for more papers by this author
  • Rashmi Chandekar MD,

    1. Division Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
    Search for more papers by this author
  • Phillip E. Rodgers MD,

    1. Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
    Search for more papers by this author
  • Francis D. Pagani MD, PhD,

    1. Department of Family Medicine, University of Michigan Health System
    Search for more papers by this author
  • Preeti N. Malani MD, MSJ

    1. Division of Geriatric Medicine, University of Michigan Health System
    2. Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    3. Section of Cardiac Surgery, Department of Surgery, University of Michigan Health System
    Search for more papers by this author

  • [See Editorial Comments by Dan D. Matlock, MD, MPH pp 154–155]

Address correspondence to Caroline A. Vitale, Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, GRECC (11G), Ann Arbor, MI 48105. E-mail: cavitale@umich.edu

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.

Ancillary