PMID- 19716036
OWN - NLM
STAT- MEDLINE
DCOM- 20100111
LR  - 20090831
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 28
IP  - 9
DP  - 2009 Sep
TI  - Thresholds of physical activity and life expectancy for patients considering 
      destination ventricular assist devices.
PG  - 863-9
LID - 10.1016/j.healun.2009.05.016 [doi]
AB  - BACKGROUND: Current implantable left ventricular assist devices (LVAD) improve 
      survival and function for patients with very late stage heart failure (HF) but 
      may also offer benefit before inotrope dependence. Debate continues about 
      selection of HF patients for LVAD therapy. We sought to determine what level of 
      personal risk and disability HF patients thought would warrant LVAD therapy. 
      METHODS: The study included 105 patients with symptomatic HF and an LV ejection 
      fraction (EF) < 35% who were given a written paragraph about LVADs and asked 
      about circumstances under which they would consider such a device. New York Heart 
      Association (NYHA) functional class, time trade-off utility, and patient-assessed 
      functional score were determined. RESULTS: Participants (mean age, 58 years) had 
      an LVEF of 21%. The median duration of HF was 5 years, and 65% had a primary 
      prevention implantable cardioverter defibrillator. Presented with a scenario of 
      bed-ridden HF, 81% stated they would definitely or probably want an LVAD; 50% 
      would consider LVAD to prolong survival if HF survival were predicted to be < 1 
      year and 75% if < 6 months. Meanwhile, 44% would consider LVAD if they could only 
      walk < 1 block and 64% if they could not dress without stopping. Anticipated 
      thresholds did not differ by NYHA class, time trade-off, or functional score. 
      CONCLUSIONS: Patient thresholds for LVAD insertion parallel objective survival 
      and functional data. HF patients would be receptive to referral for discussion of 
      LVAD by the time expected mortality is within 6 to 12 months and activity remains 
      limited to less than 1 block.
FAU - Stewart, Garrick C
AU  - Stewart GC
AD  - Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard 
      Medical School, Boston, Massachusetts 02115, USA. gcstewart@partners.org
FAU - Brooks, Kimberly
AU  - Brooks K
FAU - Pratibhu, Parakash P
AU  - Pratibhu PP
FAU - Tsang, Sui W
AU  - Tsang SW
FAU - Semigran, Marc J
AU  - Semigran MJ
FAU - Smith, Colleen M
AU  - Smith CM
FAU - Saniuk, Catherine
AU  - Saniuk C
FAU - Camuso, Janice M
AU  - Camuso JM
FAU - Fang, James C
AU  - Fang JC
FAU - Mudge, Gilbert H
AU  - Mudge GH
FAU - Couper, Gregory S
AU  - Couper GS
FAU - Baughman, Kenneth L
AU  - Baughman KL
FAU - Stevenson, Lynne W
AU  - Stevenson LW
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
SB  - IM
MH  - *Activities of Daily Living
MH  - Attitude to Health
MH  - Female
MH  - Heart Failure/*surgery
MH  - Heart-Assist Devices/*adverse effects/psychology
MH  - Humans
MH  - *Life Expectancy
MH  - Male
MH  - Middle Aged
MH  - Motor Activity
MH  - Stroke Volume
MH  - Survivors
MH  - Time Factors
MH  - Ventricular Remodeling/*physiology
EDAT- 2009/09/01 06:00
MHDA- 2010/01/12 06:00
CRDT- 2009/09/01 09:00
PHST- 2009/02/09 00:00 [received]
PHST- 2009/05/09 00:00 [revised]
PHST- 2009/05/09 00:00 [accepted]
PHST- 2009/09/01 09:00 [entrez]
PHST- 2009/09/01 06:00 [pubmed]
PHST- 2010/01/12 06:00 [medline]
AID - S1053-2498(09)00359-3 [pii]
AID - 10.1016/j.healun.2009.05.016 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2009 Sep;28(9):863-9. doi: 10.1016/j.healun.2009.05.016.