“That means the vast majority of patients who receive these devices are still alive and well two and three years later,” he said. “The longest-living LVAD patient in our program is approaching five years as of this March.”
Device is last resort
Many patients would be candidates for heart transplants, but about 3,000 Americans are on the waiting list for a heart transplant on any given day, according to the National Heart, Lung and Blood Institute. About 2,000 donor hearts are available every year.
About 5.8 million people in the United States suffer from heart failure, according to the institute.
Patients who receive ventricular assist devices are generally some of the sickest people in the hospital and have no more last resorts, said Dr. Edward Kasper, director of clinical cardiology at Johns Hopkins Hospital in Maryland.
Kasper said for that reason, the mortality rate among left ventricular assist device patients remains high.
“This is a person who has received pretty much everything else that they could possibly get in terms of medications and reparative surgery, and it has failed,” Kasper said. “They're still horribly limited by heart failure symptoms, and that's when you start thinking about left ventricular assistance.”
Research shows that the survival rate can range greatly, depending on the age and health of the patient.
A study published in the New England Journal of Medicine in 2009 showed that two years after surgery, there was a 58 percent survival rate. The Mayo Clinic reports a survival rate of 74 percent.
The device costs about $70,000. Medicare will reimburse hospitals somewhere between $100,000 and $110,000 for the procedure, Horstmanshof said.
Kasper, who has served on Hopkins' ethics board, is aware of the debate about whether people who are as sick as LVAD patients should get a costly procedure.
“The fact of the matter is that when I'm in the room with the patient, I have to think about what's best for the patient, not what's best for society,” Kasper said.
“I don't actually think about the cost of it, unless the patient doesn't have insurance, but then I'm trying to figure out, ‘How can I get this patient insured?' And not, ‘Is putting in an LVAD the best thing for society?' It puts us, as physicians, in a very conflicted role if we're supposed to be thinking about what's best for the patient and what's best for society.”