Advanced Heart Failure Therapies in Carceral Settings: LVAD Evaluation in an Incarcerated Patient.

CLINICAL CONDITION: Evaluation for advanced heart failure (HF) therapy, including left ventricular assist device (LVAD) placement, in an incarcerated patient. KEY QUESTIONS: The key questions are the following: 1) how does incarceration impact cardiovascular risk?; 2) how does incarceration affect advanced HF therapy evaluation, and what legal and ethical considerations apply?; 3) what are the logistical challenges of managing LVAD therapy in the carceral setting?; and 4) what legal pathways exist for medically complex incarcerated patients, and how can clinicians advocate effectively on their behalf? OUTCOME: The patient was approved for LVAD placement. Shortly before LVAD implantation, he was approved for medical parole. He successfully underwent LVAD placement, was discharged home, and is now undergoing evaluation for heart transplantation. TAKE-HOME MESSAGES: Incarceration should not exclude patients from advanced HF therapies. Medical parole should be considered when ongoing care exceeds a facility's capabilities.