Abstract
Heart failure affects more than 5 million people in the United States. Left ventricular assist devices (LVADs), originally designed as a bridge to heart transplantation, are now implanted as either a bridge to transplantation or as a destination therapy for those individuals who are not transplant candidates. Left ventricular assist devices have improved survival and may improve the quality of life for many individuals. However, individuals who originally had LVADs implanted as a bridge to transplantation may be delisted because of changes in health status and, like those with LVADs as destination therapy, will live with this therapy until the end of life. Decision making can become more complicated when adverse effects or comorbid health conditions cause a significant decline in health status. Challenges related to informed consent, advance care planning, quality of life, and end-of-life care in this population will be discussed. Clinical interventions will be addressed to improve care in this growing population.