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Did news coverage of Cheney's LVAD minimize risks?

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I was troubled by some of the network TV news coverage I saw about former Vice President Dick Cheney getting a left ventricular assist device. So I turned to a journalist who knows a lot about such issues – Mary Knudson, co-author with Edward K. Kasper M.D. of Living Well with Heart Failure, the Misnamed, Misunderstood Condition. Here are Mary’s comments:

The main problems I saw with coverage of former Vice President Dick Cheney getting a device implanted to treat his worsening heart failure was absence of reporting about the huge risks associated with this procedure. Below are some points to include in balanced reporting about an LVAD:

A left ventricular assist device (LVAD) can be an effective means of treating heart failure short term, but is much riskier and more complex than implanting a pacemaker. The LVAD is a pump that does the work for a weak left ventricle, removing blood from the left ventricle and pumping it into the aorta where it then flows to the rest of the body. The newer model smaller pump is implanted in the chest and has tubes leading to the left ventricle and aorta and another that goes outside the body to connect to a computerized controller. The controller can be worn on the waist and operated by batteries. The LVAD is used in people with heart failure that is so severe, medications do not prevent shortness of breath and fatigue. The device is used in someone with end-stage heart failure as a bridge to keep a person alive until he can get a heart transplant or as a final treatment that may prolong his life up to 10 months to two years or sometimes longer.

While the LVAD can dramatically improve the quality of a person’s life by relieving the symptoms that prevent activity, it is a procedure that carries a great deal of risk. Death can occur during the procedure, in the first few days after it, or after the person returns home. Risks include infection, blood clots, bleeding, device failure, and quite a few others.

Using the newest model of LVAD, a person can go about daily activities by carrying with him a couple of sets of battery replacements and then at night connecting the LVAD to a laptop computer that is plugged in to an electrical outlet. Or the person might work at an office or at home with the LVAD plugged through the computer to an electrical outlet. The LVAD has come a long way from the noisy large stationary power sources patients were tethered to. Newer units are smaller, portable for hours, and quieter. But the risks are the same and this device is used as a last resort.

The TalkingPointsMemo site did focus on the potential harms and risks. And a TPM reader submitted this comment:

“I’m a surgeon and just read your wire story about Dick Cheney getting a Left Ventricular Assist Device (LVAD) placed. The story downplays the seriousness of that procedures…once you’ve got an LVAD in place, it means your heart is essentially incapable of working on its own and has no potential to improve. While LVAD outcomes have been improving, and some patients live months or even years with one of these devices in place, this is a HUGE operation with MAJOR associated morbidity and mortality. If he’s not listed for a heart transplant, his days are seriously numbered. Life on an LVAD isn’t something I’d wish on my worst enemy…an axiom that this situation really tests. He’s in for a rough time.”

Exaggerating potential benefits and minimizing potential harms is a troublesome trend in health care news – something we’ve documented on HealthNewsReview.org.

It’s ironic that the Cheney LVAD story occurred on the same day the New York Times ran a relatively unquestioning piece about a French artificial heart device. Scrutiny of the evidence for medical devices – big or small – is an important area of improvement for health care journalists.

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Comments (38)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Norm Nantel

July 15, 2010 at 4:11 pm

I worked at Thoratec and wish to respond to the above comment: “…once you’ve got an LVAD in place, it means your heart is essentially incapable of working on its own and has no potential to improve”.
Some patients on LVAD experience a restoration of heart function over time and can be weaned off the LVAD.

Gary Schwitzer

July 15, 2010 at 4:45 pm

Norm,
Thanks for your comment.
I can’t speak for the author’s (Mary’s) intent, but her “essentially incapable” seems to have some flex in it.
If your statement is correct that “some patients” can be weaned off the LVAD, I’d like to see hard numbers for that. How many people? Out of how many on the device? Over what period of time? And weaned for how long? With what outcomes/quality of life?

Mary Knudson

July 15, 2010 at 4:59 pm

It was not I who made the comment Norm Nantel refers to that “once you’ve got an LVAD in place, it means your heart is essentially incapable of working on its own and has no potential to improve.'” That comment was made by the unnamed Talking Points Memo reader who called himself a surgeon that Gary included just after my comments had ended.
In fact, while some of the TPM comments are right on target, I agree with Norm that a very small percent of people who get an LVAD implanted do recover some of their heart function.

Gary Schwitzer

July 16, 2010 at 7:49 am

Mary,
My apologies for attributing that comment to you. You are correct: that comment came from the unnamed surgeon who posted on the TPM blog.
Sorry for the confusion.

Sherry Kirkeby

July 16, 2010 at 10:43 am

In response to the surgeon’s statement that he would wish an LVAD on his worst emeny. It’s too bad he’s condemning of a procedure that gives life and hope to those who are facing certain death. My father received an LVAD when he was on death’s door and heart transplant was not an option. Yes, it was touch and go, but he came through and went on to live almost 4 years and be here with us. Four years and he traveled, was around for weddings, births, and all family milestones that he would have missed. His life changed, but once we became familiar with the routine, life went on. In the end the LVAD was going strong and it was cancer that ended his life. I write this for people like my father, who have no other options. Don’t listen to that surgeon. LVAD was a blessing and we thank Thoratec everyday.

k Huegele

July 17, 2010 at 4:52 pm

I have been a critical nurse for going on 30 years & have worked with LVADS for many of those. There are risk in taking your gallbladder out, & that surgery too can kill you. I have seen many people wean from LVADS & go on to live many years, especially young post partum mothers!!! What risk would you not take for a young family with a new baby that pregnancy took a toll on her heart? Thankfully we have options in an LVAD to offer so she can heal her heart. When a patient faces the options of destination therapy they know there are no absolutes or guarantees. But when faced with these decisions their quality of life has reached a point their heart alone can no longer sustain them. Often transplant is not an option. For Ms Kirkeby & her family, how can you say the risk was not “worth it” for them? How can you question what value “time” has to someone’s loved one? “quality of life” will be a never ending controversy and we deal with that every day in my profession. But we have ongoing options and thankfully, for right now, we HAVE healthcare options! Think about that choice…options. We may not have that much longer. And Norm, we wean people from LVADS all the time! Medicine is NOT a perfect science! But I thank God we have options.

SAM D REYES

July 24, 2010 at 11:52 am

On the positive side, he is surrounded by the best authorities in this field and also that is Mr. Cheney’s choice, willing to take whatever risks there are, be included into the few trial groups for this HEARTMATE II, THE LATEST LVAD…is going to be his earnest contribution to the medical success in treating end stage CHF. As a surgeon, i feel that giving his failing heart a break with this latest generation device, it may give his heart the needed break and time to heal somehow or…he may opt at getting a stem cell infusion in the future which is also experimental… but acceptable in some institutions. Good luck to him.
I am very much in agreement with Critical Nurse Ms K. Huegele…that is almost always…patients, if there is a way and a chance to improve their quality of life…they will opt in getting it.

Gary Schwitzer

July 24, 2010 at 9:29 pm

I remind a couple of the commenters that this blog is almost always about – and this original post was solely about – NEWS COVERAGE.
It was about the balance – or lack thereof – in the NEWS COVERAGE of the tradeoffs involved in these devices.
The Publisher

G. Creager

August 9, 2010 at 5:27 pm

Back in the dark ages, before Thoratec was pretty much the sole powerhouse, Gould and several other manufacturers were involved with centers around the country in the development of pulsatile and pulseless VADs. I was involved in some of that work for over 5 years, and have seen clinical and lab-animal scenarios where VADs were implanted. As a researcher, I’ve collected and analyzed the results. Realize that I’ve now been out of that area of research for some time, but I still read the reports as I see them.
There are several forms of VAD that can be implanted. These range from emergent devices threaded up the descending aorta into the left ventricle. A caged impeller forces blood from the ventricle, out the aortic valve and into the ascending aorta. These devices can be left in place for a relatively short period of time, but may be sufficient to allow restoration of ventricular function in some (few) cases.
The HeartMate II requires that a core be removed from the left ventricular apex, and that the pump be situated between the portal in the ventricle (a rigid tube, usually connected to the VAD pump by a Dacron graft) and the aorta. A valved graft is attached to the outflow of the pump.
Other forms of VAD, both electrical and pneumatic powered have been used in the past. Several of these continue in service today.
As ongoing studies are the norm, few centers release significant survival statistics, but what can be gleaned from the literature suggests good results. Despite ventricular coring, patients HAVE recovered from VAD implantation, have left the hospital with the devices in place, and have, in fact, been weaned from them and released. Once viewed solely as a bridge to transplantation, it has been demonstrated that these devices provide an ability to rest a failing heart, allowing it to heal in some cases, allowing the patient the opportunity simply to survive to transplantation in others, and allowing for an improved quality of life when transplantation is not an option.
Is an operation of this magnitude risk-free? Hardly, but it is not unheardof, nor overly difficult for the surgeon trained in the procedure and with the device. It can be dangerous, depending on the gravity of the disease state. It’s not always successful. But, when you’re treating end-stage heart disease, a lot of things aren’t successful.
I don’t think the risks were downplayed. I think the respondents who felt they were have never seen the device implanted and managed by surgeons who were truly well-versed in the LVAD.

M. Joshua Morris

August 10, 2010 at 9:38 pm

I agree with Norm @ Thoratec, I have a Thoratec Heartmate2 LVAD. The Surgeon is incorrect in stating that the heart is rendered useless once the LVAD is grafted to the Native Heart. Improvement to the damaged heart does occur, although not all hearts are restored to “normal” but some LVADs are being removed and a transplant is not needed. It is certainly case to case but my EF was @ 5% post heart attack and now my EF is 20%. 20% is not enough to remove the LVAD or take me off the Waiting list, but this hibernation period for the heart while i am with the LVAD does prove that the LVAD HELPS the heart in repairing/restoring itself. If you want more details,info and facts you can visit my blog… thanks.

Tamyra

November 3, 2010 at 3:55 pm

Hello,
I am one of those individuals who has received the device and it has helped my heart improve over the last few months. So much so, my team and I are discussing possible removal after 6 months of having the device.
Life is a risk. Once you have this condition it not a matter of if you will die but when? The decision for LVAD was a no brainer because nothing could have been worse than my state two weeks prior to getting the device.
This option has provided me with the ability to ride my bike, work full time, skate, hang with friends, etc while waiting on a heart.
Life is not perfect but it is good!!!!

Gary Schwitzer

November 3, 2010 at 4:27 pm

Tamyra,
As I’ve reminded other commenters earlier, this blog is almost always about – and this original post was solely about – NEWS COVERAGE.
It was about the balance – or lack thereof – in the NEWS COVERAGE of the tradeoffs involved in these devices.
It was not about individual decision-making.
The Publisher

Craig Usas MD

December 1, 2010 at 4:35 pm

With deference to Mr. Schwitzer’s repeated insistence that “this blog…was about the balance – or lack thereof-in the NEWS COVERAGE of the tradeoffs involved in these devices…”, suggesting of course that every poster had read every piece of news coverage on this topic, I would observe the following:
1.Destination LVADs,now “covered” by Medicare, are unconscionably expensive (Thoratec charges $65,000! for a single LVAD device; hospital charges add an additional $200,000 or so and “professional fees” are additional to those charges). The implantation of an LVAD (destination or bridge) thus runs, conservatively, one third of a million dollars. I am unaware of a single piece of NEWS COVERAGE which addressed this and can only conclude there was no balance in coverage whatsoever.
2. CHF is primarily age-related. It is epidemic in proportion and growing literally daily.Given the costs above and given that the vast majority of destination LVAD candidates are covered by Medicare, it is a foregone conclusion that the aggregate cost (estimated by some experts as exceeding $100 billion) will mandate ever-tighter qualifying restrictions and ad hoc rationing of care.
If I am correct, this issue was likewise not seen in NEWS COVERAGE.
3. Whether a former USVP received an LVAD or didn’t seems to me a superfluous issue. What is fundamental, however, is that we as a society have now confronted for the first time the reality that 3 does not go into 7 evenly and that the future of American healthcare is in serious jeopardy; that many will die not for lack of “life-saving technology”, but simply because we, as a society, cannot afford it… yet another issue not addressed in the NEWS COVERAGE of this issue.
Thank you.

GHillbert

March 7, 2011 at 11:06 pm

Gary, you were the one who posted the info slanted towards negative reflections on the LVAD including frankly ridiculous comments by the TPM “surgeon”. Although your point is news coverage, it is irresponsible to publish inaccurate information, given that potential LVAD patients could google this page (as I did) and get an inaccurate impression of the technology and/or procedure.
“Some points to include in balanced coverage” would be:
– LVAD survival with new generation devices is similar to transplant
– LVAD can prolong the time until someone needs a transplant (which is a finite solution as they last a limited amount of time)
– People with end-stage heart failure have dismal survival prospects of less than 8% at 2 yrs (in one RCT), similar to a “bad” cancer – if your choices are dead or LVAD, then an LVAD looks pretty good
– People have survived on LVAD for 6-7 years with current generation devices (a lot more than 10 months to 2 years stated)
– Risks of LVAD implant are NOT “the same” as when there were “noisy large stationary power sources patients were tethered to”. Adverse event rates have significantly reduced since the initial uses, and even since the original RCT proving LVAD was superior to optimal medical management of end-stage heart failure in 2001
– Bridge to recovery is a valid implant option. Success in both the short and longterm primary relies on the implanting center’s expertise at identifying the patients who may be weanable, and their experience in doing so. Certainly any time that is gained on or off the VAD, even if transplant is the eventual outcome, delays the time at which the transplanted organ fails (or transplant therapy causes fatal side effects)
– The statement that “his days are seriously numbered. Life on an LVAD isn’t something I’d wish on my worst enemy…an axiom that this situation really tests. He’s in for a rough time.” is erroneous and misleading. Patients consistently report improved quality of life on an LVAD compared to end-stage heart failure on medical therapy.

Twink

April 11, 2011 at 1:23 pm

Yesterday we lost our dear friend who had her LVAD for nearly 2 years. She has suffered immensely and only she knows if it was worth it. I can say that from personally observing her “quality” of life….No thanks! Her friends have been left to wonder whether she was a “guinea pig” on behalf of medical research. She had so many complications that she was unable to participate in even the most simple things that she enjoyed. Obviously, this is a very individual decision that needs to be made by the patient. My friend agreed to the LVAD since her immediate family members were more distressed than she by her worsening heart disease. Let me just say that none of us would wish this on our worst enemy after observing her suffering these last 2 looong years. I am thankful that she was able to finally turn the damned thing off and die in peace.
What I’ve learned from this? I will think long and hard before agreeing to any foreign life-sustaining measure. There are no guarantees. We believe that the medical community had every desire to keep our friend alive….to ensure better survival statistics. Our friend was now “owned” by the device and she was going to live until they reached whatever benchmarks they had to. Sorry to sound so bitter…but after watching this play out in person….we’re all sick at heart. RIP my dear friend. We are thankful you are finally at peace and your terrible suffering has ended.

Edward Craxton

July 25, 2011 at 8:25 am

A different side of the story from that experienced by Twink’s friens. I was given a HeartWare LVAD nearly a year ago (I am British, with end-stage heart failure, and come under the superb, wonderful British National Health Service where you don’t have to worry about insurance!). Before that I was given a life expectancy of between 1 – 2 years. OK, the stay in hospital was grim, as much for the length of time (30 days) as anything, and it’s a bore wearing the controller and batteries ALL the time, not to mention the spares when going out, but my life has improved immeasurably – better mobility, less breathlessness, less faatigue – so that I can live pretty well a normal life. Now waiting for a heart transplant.

Angel Cregger

September 12, 2011 at 2:44 pm

Thank you Twink for sharing. I have had a LVAD for 3 years, I am brige to transplant. I have had nothing but problems and side effects from the LVAD. I tell people all the time I love it and love to hate it. I have struggled as your friend did. I am so glad to know I am not alone. I am told constantly how good I look and how great the device is but those people don’t see the constant side effects I face. Thank you and God Bless.

Phyllis Burr

October 3, 2011 at 5:24 pm

My dear Husband had a heart mate II In Nov 2010 & died Jan 2011.
After seeing all that is involved I would never have one. Nursing homes in many states will not take these people as they do not know how to care for these people/

cathy ruis

April 6, 2012 at 6:48 pm

My husband got his Lvad 11/19/2011
I can not say one good thing about it. I’m a RN and feel like a car sales man sold us a car we didn’t need and didn’t wantt but were scared into it with lies about how this and that were failing. Well we bought the car and got a lemon. Life has been hell every since for both of us with one complication after another. Also the stress and anxiety is effecting the entire family. Even our little grand daughters.

cathy ruis

April 6, 2012 at 6:48 pm

My husband got his Lvad 11/19/2011
I can not say one good thing about it. I’m a RN and feel like a car sales man sold us a car we didn’t need and didn’t wantt but were scared into it with lies about how this and that were failing. Well we bought the car and got a lemon. Life has been hell every since for both of us with one complication after another. Also the stress and anxiety is effecting the entire family. Even our little grand daughters.