VAD Coordinator Memorial Hermann Center for Advanced Heart Failure Cypress, Texas, United States
Disclosure(s):
Ashley Kelly, BSN, RN, PCCN, VAD-C: No financial relationships to disclose
Background: The presence of durable MCSD presents unique complexities and barriers to hospice care in this patient population. The purpose of this presentation is to analyze the similarities and differences of two cases of durable VAD patients in hospice care and evaluate opportunities to improve hospice experiences for this patient population.
Methods: Methods used include literature review, electronic health record review, and institutional process review.
Outcome: Patient #1: - Robust family support - Chronic deterioration of AHF (RV failure), poor volume removal with HD and oral diuretics impacting quality of life (QOL) - Multiple hospitalizations led to earlier discussions re: goals of care, QOL -> patient and family accepting of prognosis and at peace with decision to pursue comfort measures - Patient passed away at home - Patient’s family reported patient died peacefully and was able to spend time with family members
Patient #2 -Poor family support and tension within family unit -Barriers to timely clinic and lab follow up, namely transportation -Acute lung cancer diagnosis with no treatment options -Patient developed suspected pump thrombosis with elevated LDH levels and high watt alarms Patient and family not accepting of prognosis -Patient’s VAD started alarming, family changed controller causing pump malfunction, VAD failed to re-start -> family rescinded OOH DNR and requested emergent Life Flight transport to TMC -Patient passed away in hospital -Experience caused more stress to patient and family at end-of-life (EOL)
Conclusion: Factors affecting EOL experience for VAD patient on hospice support: -Family support -Chronic vs. acute deterioration -Perception of QOL -Acceptance of prognosis -VAD alarms and responsibility of VAD deactivation
Opportunities for improvement: -Earlier goals of care discussion with clinical decline -Outpatient supportive medicine -Improved VAD specific education for hospice team
