Advanced Therapies- LVAD, FT, MV, HD

Question 1

What are the sequelae of feeding tube placement in patients with advanced dementia?

Answer 1

1) 1/3rd require physical or chemical restrains
2) 1 in 5 (20%) experience a tube related complication requiring hospital transfer/admission
3) 1/3rd may have transient MILD GI side effects (nausea/vomiting) but serious complications are rare
4) It does NOT extend life or improve QOL or reduce aspiration pneumonia risk (only good oral care can help with that)

Question 2

What is the impact of NIPPV for patients with ALS and normal or moderately impaired bulbar function?

Answer 2

Improves QOL and has a survival benefit

Question 3

Impact of initiation of HD among nursing home residents?

Answer 3

1) Majority (58%) die within a year
2) Within 3 months, 61% either had died or had decrease in functional status– i.e. functional status WORSENS

Question 4

What is the 2 year survival rate for LVADs? What factors predict poorer survival? (5)

Answer 4

LVADs have shown significant mortality benefits, with a 2-year survival of 58% for the newer continuous-flow devices

( Observational studies demonstrate 2-year survivals of 72%)

1) poor nutritional status (hypoalbuminemia)
2) coagulopathy
3) baseline renal dysfunction
4) right heart dysfunction
5) care at a less experienced MCS center

Of those patients who are alive at 2 years, 79% will improve their NYHA functional class from class IV to class I, and health-related quality of life will improve by 178% (5). Readmission rates have reduced significantly as well