Aims:
Patients who apply for VAD in Victoria, Australia are required to have a prognosis of less than six months, or less than 12 months for neurodegenerative conditions. Applications for VAD require six steps and it is mandatory for practitioners to record the dates of completion. Analysing data relating to the length of time associated with applications can highlight barriers and inform discussion with patients, legislative review, and service provision.
Methods:
Deidentified consultation records were submitted by members of the VAD Community of Practice (CoP), a voluntary online forum for VAD-trained doctors in Victoria with 39 members, representing 25% of doctors involved in one or more case. Dates of completion of each step were used to calculate the average time taken to complete the process. Descriptive statistical analysis was undertaken.
Results:
344 cases were submitted by 10 members of the CoP. Demographics of submitted patients were similar to the total cohort reported in the VAD Review Board (VADRB) report.
Completion of each stage was (number of patients): First request (344), First assessment (342), Consulting assessment (299), Final request (192), Permit issued (175), Medication dispensed (146, representing 44% of total patients).
The median time to receive medication was 36 days. 114 cases were withdrawn: 112 (98%) due to death prior to receiving VAD medication, and one each for loss of capacity and short prognosis. For those withdrawn due to death, the median time from first request to death was 20 days (range 2-335), and 82 patients (73%) survived less than the median time to receive medication.
Conclusion:
VAD application is a time-consuming process relative to the prognosis of applicants. Attrition is high, particularly between consulting assessment and final request. The average time to complete the application process is longer than many applicants’ survival times.