A 76-year-old man with systolic heart failure presented to the advanced heart failure service after optimal medical management including biventricular pacing failed to improve his symptoms. A left ventricular assist device (LVAD) as destination therapy was offered to the patient after he was determined not to be a transplant candidate owing to advanced age. The risks and benefits of such a device were discussed with the patient and his family. Although the family had noticed some subtle hints of changes in his memory, such as repeating questions, word-finding difficulties, and missing appointments, these issues were not brought to the attention of the medical team, nor were they evident during multiple clinical encounters. Formal cognitive testing was not documented.
Rogers SE, Klein L, Perissinotto CM. The Importance of Cognitive Assessment Before Ventricular Device PlacementA Teachable Moment. JAMA Intern Med. 2015;175(6):890. doi:10.1001/jamainternmed.2015.0468