Comorbidities and the decision to undergo or forego destination therapy left ventricular assist device implantation: An analysis from the DECIDE-LVAD study

Abstract Background Patients considering destination therapy left ventricular assist devices (DT LVAD) often have high comorbid burden but the association between these comorbidities and post-decision outcomes is unknown. Methods We included subjects in DECIDE-LVAD ( NCT02344576 ), a stepped-wedge multicenter trial of patients considering LVADs, recording comorbidities per INTERMACS protocol. We compared decisional conflict, regret, perceived stress, quality of life (EQ-VAS), depression (PHQ-2), struggle with- and acceptance of illness by comorbid burden and amongst the most common comorbidities. Results Of 239 patients, LVAD recipients (n = 164) and non-recipients (n = 75) had a similar proportion with ≥1 comorbidity (70% v. 80%, P  = .09). Patients with comorbidities were younger regardless of LVAD implantation status. After adjusting for age, overall and amongst LVAD recipients, patients with ≥1 comorbidity had higher mean decision conflict at baseline (23.2 ± 1.5 vs. 17.4 ± 2.2), and at 6 months, higher stress (13.0 ± 0.6 vs. 10.4 ± 1.0) and struggle with illness (13.3 ± 0.4 vs. 11.1 ± 0.6) than those without comorbidities ( P Conclusion P atients considering LVAD implantation with comorbidities experience increased decision conflict, stress and struggle with illness. These findings provide insights in the role comorbidities play in patient decision-making and decisional outcomes.