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To the Editor: Heart failure is a significant health care issue in the United States, with more than 5 million people currently affected and more than 50 000 deaths per year with heart failure as a primary cause.¹ As the population ages, this will become an even greater problem. Left ventricular assist devices for destination therapy are slowly emerging as the treatment of choice for appropriately selected patients. With new technology, advances in patient selection, and management and implantation at an experienced center, survival rates are now approaching 75% at 2 years.²

Although the study by Dr Hernandez and colleagues³ is a comprehensive analysis of a defined Medicare recipient group receiving ventricular assist devices, its implications and conclusions are potentially misleading regarding destination therapy. The authors cited studies of ventricular assist devices implanted for destination therapy, and in the "Results" apparently assumed that the patients they analyzed in the primary device . . . [Full Text of this Article]

Mark S. Slaughter, MD
mark.slaughter@louisville.edu
Division of Thoracic and Cardiovascular Surgery
University of Louisville
Louisville, Kentucky

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