Patients' decision making process and expectations of a left ventricular assist device pre and post implantation

ObjectivesTo examine patients' pre-implantation decision-making and pre and post-implantation expectations of left ventricular assist devices (LVADs).BackgroundLVADs have been shown to improve both quantity and quality of life of patients living with Stage D heart failure (HF). However, they also pose significant risks.Methods15 LVAD participants followed in a longitudinal study of Stage D HF patients were included in this thematic analysis.ResultsThree themes were identified: no choice; I thought I would be doing better; I feel good, but now what. Evidence from pre-implantation to post-implantation suggested that patients' perceived expectations of quality of life improvement were not met.ConclusionsIn light of their declining health, most patients felt their only alternative to implantation was death. In the post-implantation period, patients expected greater improvements in their quality of life. Evidence based guidelines for discussions of goals of care, post-implant expectations, and palliative care are necessary.