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Assessment of Palliative Care Needs in Advanced Heart Failure Patients with Left Ventricular Assist Devices
Session:
SESSÃO DE POSTERS 22 - LVAD / TRANSPLANTAÇÃO CARDÍACA
Speaker:
Inês Coutinho Dos Santos
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Coutinho Dos Santos; Márcia Presume; Cátia Sampaio; Sérgio Maltês; Bruno Rocha; Catarina Brízido; Christopher Strong; Marta Marques; Carlos Aguiar
Abstract
<p style="text-align:justify"><strong>Introduction</strong>: Durable left ventricular assist device (LVAD) implantation is a well-recognized trigger for specialist palliative care (PC) referral, as recognized by international guidelines. Despite the well-documented PC needs of this population, longitudinal PC integration remains rare in advanced heart failure (HF). Proper screening for these needs is critical to reduce suffering and improve quality of life.</p> <p style="text-align:justify"><strong>Aim</strong>: To evaluate the prevalence and characteristics of PC needs in patients under HeartMate 3™ (HM3) support, using the Integrated Palliative care Outcome Scale (IPOS).</p> <p style="text-align:justify"><strong>Methods</strong>: This cross-sectional study included all patients on HM3 support at a single center. The Portuguese patient version of IPOS was administered once to assess holistic symptom burden over the preceding week. Clinically significant unmet needs were defined as items scored ≥2 and required feedback to the attending physician for further assessment or referral.</p> <p style="text-align:justify"><strong>Results</strong>: Eleven patients (mean age 58.2 years) with HM3 support were included. LVAD was implanted for ischemic cardiomyopathy in 63.6% of cases and as a bridge to transplantation in 54.5%, with other goals including bridge to candidacy (27.3%) and destination therapy (18.2%). At a mean LVAD duration of 23.2 ± 10.6 months, 72.7% exhibited unmet PC needs, with a mean overall score of 7.73 ± 6.54 (out of 68). As main problems, two patients identified anxiety about future transplantation. 36.4% presented at least one clinically relevant physical symptom with weakness being the most troublesome. As additional symptoms, 63.6% of patients spontaneously described slight-to-moderate dizziness. Psychological needs were dominated by health-related anxiety, with a minority reporting mild depression (18.1%). On the other hand, 27.3% reported moderate spiritual distress. All patients felt adequately informed about their condition. Family anxiety (45.5%) and only partly addressed practical issues such as financial concerns (27.3%) represented the most common social challenges. Interventions following IPOS screening included one hospitalization for symptom management, three referral suggestions for social worker (n=2) and psychological (n=1) intervention. There were no significant differences between the IPOS overall score and NYHA functional classes (p=0.088).</p> <p style="text-align:justify"><strong>Conclusion</strong>: To the best of our knowledge, IPOS had never been applied to patients under LVAD support before, although clinically validated in advanced HF. While LVADs enhance survival and quality of life, significant unmet PC needs persist in this population. This study highlights the utility of IPOS in identifying these needs. Repeated use of IPOS may provide valuable insights for tracking changes over time and tailoring interventions. Further research is needed to assess the impact of systematic PC screening on quality of life in LVAD-supported patients.</p>
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