Managing Left Ventricular Assist Devices in Hospice: A Case-Based Review of Barriers and Solutions

Key Message : Few patients with LVADs access hospice care due to knowledge gaps and logistical barriers. This case-based review outlines practical approaches—including structured communication, interdisciplinary education, and collaboration with LVAD centers—to enable safe, patient-centered hospice care for individuals with mechanical circulatory support.

Abstract: Left ventricular assist device (LVAD) therapy is increasingly used for patients with advanced heart failure, with more than 27,000 implants performed in the U.S. between 2012 and 2021, 81% of which were destination therapy (1). Despite this growth, hospice utilization among LVAD patients remains low—only 15% enroll before death (2). This limited use reflects systemic and educational barriers that impede hospice access for patients supported by mechanical circulatory devices.

We present a 43-year-old man with non-ischemic cardiomyopathy status post LVAD implantation who was later diagnosed with metastatic colon cancer. He was hospitalized for liver failure due to cancer progression. Following goals-of-care discussions, he elected home hospice while maintaining LVAD support until death from cancer, rather than elective LVAD deactivation. Transitioning to hospice required close coordination among cardiology, palliative care, hospice staff, and family. Education focused on emergency preparedness and LVAD deactivation after death. After several days at home, the patient’s condition declined, likely due to multiorgan failure and circulatory collapse. When the LVAD alarmed for a low-flow state, the family deactivated the device, allowing a natural death.

This case illustrates that with intentional coordination and preparation, patients with LVADs can successfully transition to hospice and achieve a peaceful, goal-concordant death at home. While many hospices decline LVAD patients due to perceived complexities such as limited staff training, equipment unfamiliarity, and ethical uncertainty regarding device deactivation (2-4), this case demonstrates that these barriers are surmountable through proactive interdisciplinary collaboration.

Broader hospice access for LVAD patients is essential to reduce unnecessary hospital deaths and align care with patient values (5). System-level strategies—including partnerships between LVAD programs and hospice agencies, clinician education, and standardized deactivation and symptom management protocols (2,4)—can empower hospice teams to provide dignified, patient-centered end-of-life care outside the hospital.

References: 1. The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). 13th Annual Report: Outcomes of Continuous-Flow Durable LVADs, 2012–2021. Ann Thorac Surg. Published 2022. Available from: https://www.researchgate.net/publication/365952972_The_Society_of_Thoracic_Surgeons_Intermacs_2022_Annual_Report_Focus_on_2018_Heart_Transplant_Allocation_System. Accessed October 9, 2025.
2. Thompson JH, Moser D. Experiences with End-of-Life Care With a Left Ventricular Assist Device: An Integrative Review. Heart Lung. 2022.
3. Pandey D, Mahmood A, Harounian J, et al. Providing End-of-Life Care for Patients With Left Ventricular Assist Devices: Experience of a Hospice Agency. J Pain Symptom Manage. 2020.
4. Kossman DA, Wolfrom SD, Haines S, et al. Just-in-Time Interdisciplinary Education for Hospice Care of Ventricular-Assist Device Patients. J Palliat Med. 2019;22(9):1167–1169.
5. Groninger H, Gilhuly D, Walker KA. Getting to the Heart of the Matter: A Regional Survey of Current Hospice Practices Caring for Patients With Heart Failure Receiving Advanced Therapies. Am J Hosp Palliat Med. 2019;36(1):55–59.