LAUSR

BACKGROUND Left ventricular assist device (LVAD) therapy has revolutionized the treatment options for advanced heart failure patients. Patient selection is essential in obtaining successful results. However, little data exists on the outcomes of patients evaluated for LVAD therapy but subsequently rejected or deferred. METHODS This is a retrospective review of all patients referred for LVAD therapy at our institution between January 2009 to December 2016. Baseline demographics and INTERMACS profiles were collected and reasons for rejection or deferral for LVAD placement were investigated. RESULTS A total of 669 patients were referred for LVAD therapy and 228 patients (34%) were turned down. The yearly acceptance rate ranged between 57% to 75%. Average age of turned down cohort was 60.8 ± 12.5 years, 83% were men. Reasons for rejection included: too sick (34%), psychosocial concerns (25%) patient declined (16%); decision was deferred for medical optimization (15%) or patient being too well (10%). The percentage of patients that were rejected due to psychosocial concerns has increased over time (p = 0.02), while rate of deferral for medical optimization has remained stable (p = 0.10). 1-year survival after initial LVAD consult was 42% in those who were too sick, 64% psychosocial concerns, 68% patient declined, 86% medical optimization, and 100% too well (p < 0.01). CONCLUSION One-year survival is reduced among patients who were initially turned down for LVAD therapy, except in those in whom this decision was deferred for medical optimization or patient being too well. Psychosocial concerns have become a significant barrier to LVAD therapy.