20.1 Introduction
Optimal care of patients with LT-MCS, especially those in whom it is a destination therapy, has to include comprehensive end-of-life (EOL) considerations. When life-prolonging therapy can be expected to cause more suffering than benefit, palliative care (PC) should focus on quality of life and an easy death in accordance with the patient’s wishes.
Taking care of patients with LT-MCS as a destination therapy can be more difficult than taking care of HTx candidates or HTx patients [501–504]. Factors that can complicate advanced HF management such as ageing-related comorbidities, end-organ damage, cognitive impairment, frailty and limited social support are compounded by risk of MCS failure and MCS-related complications such as bleeding, infection and stroke. As a result, LT-MCS is associated with repeated hospitalizations and a high rate of caregiver burnout. The unpredictable course of advanced HF, differences among LT-MCS devices and a limited evidence base can further complicate shared decision-making, preparedness planning and EOL care [503].
Successful PC requires a multidisciplinary approach with fluid communication between the patient and caregivers on the one hand, and between primary care services, the LT-MCS team and PC specialists on the other [9, 71, 505, 506].