{
    "abstract": "The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients.\nWe conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65\u00a0years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included.\nIn 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17\u00a0months (IQR 6.3-50.3\u00a0months). Median duration between consultation and death was seven days (IQR 3-28\u00a0days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n\u2009=\u200915, after: n\u2009=\u200919, p\u2009<\u20090.001; DNR before: n\u2009=\u200920, after: n\u2009=\u200928, p\u2009<\u20090.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3-6); first contact: median 9 (IQR 6-10); p\u2009<\u20090.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit.\nThis largest European multicenter investigation of LVAD-patients receiving specialist palliative care shows a late integration and high physical and psychosocial symptom burden. This study highlights the urgent need for earlier integration to identify and address poorly controlled symptoms. Further studies and educational efforts are needed to close the gap between guideline-recommendations and the current status quo.",
    "authors": [
        {
            "affiliation": "Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.\nInterdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany.",
            "firstname": "Theresa",
            "initials": "T",
            "lastname": "Tenge"
        },
        {
            "affiliation": "Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany.",
            "firstname": "Shaylin",
            "initials": "S",
            "lastname": "Shahinzad"
        },
        {
            "affiliation": "Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.",
            "firstname": "Stefan",
            "initials": "S",
            "lastname": "Meier"
        },
        {
            "affiliation": "Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany.",
            "firstname": "Manuela",
            "initials": "M",
            "lastname": "Schallenburger"
        },
        {
            "affiliation": "Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany.",
            "firstname": "Yann-Nicolas",
            "initials": "YN",
            "lastname": "Batzler"
        },
        {
            "affiliation": "Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany. jacqueline.schwartz@med.uni-duesseldorf.de.",
            "firstname": "Jacqueline",
            "initials": "J",
            "lastname": "Schwartz"
        },
        {
            "affiliation": "Palliative Care Unit, Department of Oncology, Hematology and Bone Marrow Transplant, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.",
            "firstname": "Anja",
            "initials": "A",
            "lastname": "Coym"
        },
        {
            "affiliation": "Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany.",
            "firstname": "Johannes",
            "initials": "J",
            "lastname": "Rosenbruch"
        },
        {
            "affiliation": "Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.",
            "firstname": "Mitra",
            "initials": "M",
            "lastname": "Tewes"
        },
        {
            "affiliation": "Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf CIO ABCD, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.",
            "firstname": "Steffen T",
            "initials": "ST",
            "lastname": "Simon"
        },
        {
            "affiliation": "Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, W\u00fcrzburg, Germany.",
            "firstname": "Carmen",
            "initials": "C",
            "lastname": "Roch"
        },
        {
            "affiliation": "RH\u00d6N-Klinikum AG, Campus Bad Neustadt, Bad Neustadt an Der Saale, Germany.",
            "firstname": "Ute",
            "initials": "U",
            "lastname": "Hiby"
        },
        {
            "affiliation": "Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.",
            "firstname": "Christian",
            "initials": "C",
            "lastname": "Jung"
        },
        {
            "affiliation": "Department of Cardiac Surgery, Medical Faculty and, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.",
            "firstname": "Udo",
            "initials": "U",
            "lastname": "Boeken"
        },
        {
            "affiliation": "Palliative Care Center Basel, Basel, Switzerland.\nDepartment of Clinical Research, University of Basel, Basel, Switzerland.",
            "firstname": "Jan",
            "initials": "J",
            "lastname": "Gaertner"
        },
        {
            "affiliation": "Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.\nInterdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany.",
            "firstname": "Martin",
            "initials": "M",
            "lastname": "Neukirchen"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1186/s12904-024-01563-8",
    "journal": "BMC palliative care",
    "keywords": [
        "Heart failure",
        "Heart-assist devices",
        "Multicenter study",
        "Palliative medicine",
        "Quality of life",
        "Retrospective studies"
    ],
    "methods": null,
    "publication_date": "2024-09-24",
    "pubmed_id": "39313780\n35150240\n34447992\n35363500\n33465365\n37219893\n33059016\n32319317\n32101304\n21875515\n28705314\n36921886\n33931802\n35845069\n33825815\n37327912\n36964550\n28812945\n20882300\n25249239\n34080439\n28504892\n27758809\n24094703\n21628614\n38778297\n29874117\n32464259\n26998594\n28711755\n30794023\n29307849\n33155042",
    "results": "In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17\u00a0months (IQR 6.3-50.3\u00a0months). Median duration between consultation and death was seven days (IQR 3-28\u00a0days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n\u2009=\u200915, after: n\u2009=\u200919, p\u2009<\u20090.001; DNR before: n\u2009=\u200920, after: n\u2009=\u200928, p\u2009<\u20090.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3-6); first contact: median 9 (IQR 6-10); p\u2009<\u20090.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit.",
    "title": "Multicenter exploration of specialist palliative care in patients with\u00a0left ventricular assist devices - a retrospective study.",
    "xml": "<Element 'PubmedArticle' at 0x788506223290>"
}