The foremost and greatest barrier to end-stage heart failure treatment: the impact of caregiver shortage

• Published in: Journal of artificial organs Vol. 28; no. 2; pp. 192 - 197
• Main Authors: Saito, Shunsuke, Yoshioka, Daisuke, Kawamura, Takuji, Kawamura, Ai, Misumi, Yusuke, Akazawa, Yasuhiro, Sera, Fusako, Kubota, Kaori, Yamauchi, Takashi, Sakata, Yasushi, Miyagawa, Shigeru
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.06.2025; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Biomedical Engineering and Bioengineering; Cardiac Surgery; Caregivers; Caregivers - supply & distribution; Congestive heart failure; Diabetes mellitus; Dialysis; Drinking behavior; Failure; Female; Health services; Heart failure; Heart Failure - therapy; Heart transplantation; Heart Transplantation - statistics & numerical data; Heart-Assist Devices; Hospitals; Humans; Japan; Male; Malignancy; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original; Original Article; Patients; Retrospective Studies; Social conditions; Therapy; Japan; Left ventricular assist device; Home therapy; Heart transplantation; Caregiver
• ISSN: 1434-7229; 1619-0904; 1619-0904
• DOI: 10.1007/s10047-024-01463-x

We examined the number of patients abandoning cardiac replacement therapy due to the inability to secure a designated caregiver. At Osaka University Hospital Heart Center, when we receive a consultation for a patient with severe heart failure from another hospital, a heart failure team makes a visit to the referring hospital as soon as possible. We retrospectively analyzed this hospital-visit database. We received 199 severe heart failure consultations from 2016–2023. Issues identified during hospital visits included age ≥ 65 years (8%), inability to confirm the patient’s intention (8.5%), and explicit refusal of therapy (2.5%). Medical problems included multiple organ failure (18.1%), obesity (13.1%), diabetes (9.5%), malignancy (5.5%), chronic dialysis (1.0%), and other systemic diseases (12.6%). Adherence problems included poor medication compliance (3.5%), history of heavy drinking (2.5%), and smoking (2.0%). Social problems included inadequate family support in 16.1% of patients. Of the 199 patients, 95 (48.0%) proceeded to a heart transplant and LVAD indication review meeting at Osaka University Hospital. The remaining 104 patients (52.0%) did not proceed to the meeting. Reasons included improvement of heart failure with conservative treatment in 37 cases (35.6%), death before discussion in 21 cases (20.2%), medical contraindications in 18 cases (18.3%), lack of caregivers in 18 cases (18.3%; 9.5% of 199 cases), and patient refusal in 5 cases (4.8%). Approximately 10% of patients consulted at Osaka University Hospital Heart Center for severe heart failure abandoned cardiac replacement therapy due to the lack of caregivers.