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Dark side of the moon - Suicide after LVAD-implantation as a destination therapy

"Left ventricular assist devices (LVAD) are increasingly used in patients with end-stage heart failure as a destination therapy. Not all patients benefit durably from their improved quality of life under VAD-support. For some of them many psychological items might be a source of problems in their life far from normal. Depression and anxiety are well-documented in patients with end-stage heart failure and correlate with a higher risk of suicide," Dr. Katharina Tigges and coleagues (Bad Oeynhausen/Germany) emphasize.

They "report about a 69 yrs old, depressive patient, who committed suicide by disconnecting his driveline almost three years after implantation of a LVAD. We provide a medical, psychological and psychiatric background of this unique case. To the author’s knowledge, a published report of suicidal attempts after LVAD implantation does not exist.

The device itself might give depressive patients a new opportunity of committing suicide. The inhibition threshold seems to be dramatically decreased by an every day handling like changing the batteries or connecting/disconnecting the driveline of the controller in comparison to more rude suicidal attempts like hanging oneself or shooting oneself down.

This report highlights the importance of pre-implant psychological screenings, the need for regular and long-term psychological support for this vulnerable patient population, and the need for more research on the patients’ views on "living with an LVAD" (qualitative research), together with research exploring risk profiles for depression/suicide. A debate about palliative care and end-of-life decisions after LVAD implantation as a destination therapy would be helpful as well."