OBJECTIVE
To assess the benefit of proactive palliative medicine consultation for delineation
of goals of care and quality-of-life preferences before implantation of left ventricular
assist devices as destination therapy (DT).
PATIENTS AND METHODS
We retrospectively reviewed the cases of patients who received DT between January
15, 2009, and January 1, 2010.
RESULTS
Of 19 patients identified, 13 (68%) received proactive palliative medicine consultation.
Median time of palliative medicine consultation was 1 day before DT implantation (range,
5 days before to 16 days after). Thirteen patients (68%) completed advance directives.
The DT implantation team and families reported that preimplantation discussions and
goals of care planning made postoperative care more clear and that adverse events
were handled more effectively. Currently, palliative medicine involvement in patients
receiving DT is viewed as routine by cardiac care specialists.
CONCLUSION
Proactive palliative medicine consultation for patients being considered for or being
treated with DT improves advance care planning and thus contributes to better overall
care of these patients. Our experience highlights focused advance care planning, thorough
exploration of goals of care, and expert symptom management and end-of-life care when
appropriate.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection.Circulation. 2007; 116: 497-505
- Improving outcomes with long-term “destination” therapy using left ventricular assist devices.J Thorac Cardiovasc Surg. 2008; 135: 1353-1360
- Left ventricular assist devices as destination therapy: a new look at survival.J Thorac Cardiovasc Surg. 2005; 129: 9-17
- Long-term use of a left ventricular assist device for end-stage heart failure.N Engl J Med. 2001; 345: 1435-1443
- Advanced heart failure treated with continuous-flow left ventricular assist device.N Engl J Med. 2009; 361: 2241-2251
- Transformation of LVAD destination therapy, “good to great”: ever increasing survival benefit [abstract 3662].Circulation. 2009; 120: S844
- Withdrawal of ventricular assist device support.J Palliat Care. 2005; 21: 151-156
- Ethical challenges with the left ventricular assist device as a destination therapy.Philos Ethics Humanit Med. 2008; 3: 20
- The financial burden of destination left ventricular assist device therapy: who and when?.Curr Cardiol Rep. 2007; 9: 194-199
- Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure.Int J Palliat Nurs. 2006; 12: 566-573
- “the pit and the pendulum,” and ventricular assist devices.Crit Care Nurse. 2009; 29: 29-39
- Self-care demands of persons living with an implantable left-ventricular assist device.Res Theory Nurs Pract. 2009; 23: 279-293
- Community support of patients with a left ventricular assist device: the Toronto General Hospital experience.Can J Cardiol. 2009; 25: e377-e381
- Ventricular assist devices the challenges of outpatient management.J Am Coll Cardiol. 2009; 54: 1647-1659
- Ethics guidelines for destination therapy.Ann Thorac Surg. 2006; 81: 1185-1188
- The use of advance directives among patients with left ventricular assist devices.Hosp Pract (Minneap). 2011; 39: 78-84
- Continuous-flow left ventricular assist device [letter].N Engl J Med. 2010; 362: 1149
- Destination nowhere: a potential dilemma with ventricular assist devices.ASAIO J. 2008; 54: 1-2
- Elective inactivation of total artificial heart technology in non-futile situations: inpatients, outpatients and research participants.Death Stud. 2004; 28: 423-433
- When withdrawal of life-sustaining care does more than allow death to take its course: the dilemma of left ventricular assist devices.J Heart Lung Transplant. 2001; 20: 544-548
- Ethical analysis of withdrawing ventricular assist device support.Mayo Clin Proc. 2010; 85: 791-797
- Destination ventricular assist devices for heart failure #205.J Palliat Med. 2009; 12: 956-957
Schwarz ER, Philip KJ, Simsir SA, et al. Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick [published online ahead of print February 27, 2010]. J Relig Health. Doi: 10.1007/s10943-010-9326-y.
- Making sure services deliver for people with advanced heart failure: a longitudinal qualitative study of patients, family carers, and health professionals.Palliat Med. 2009; 23: 767-776
- Palliative care in congestive heart failure.J Am Coll Cardiol. 2009; 54: 386-396
- Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology.Eur J Heart Fail. 2009; 11: 433-443
- A comparative study of the palliative care needs of heart failure and cancer patients.Eur J Heart Fail. 2009; 11: 406-412
- Palliative care for patients with heart failure.JAMA. 2004; 291: 2476-2482
- Hospitalization as an opportunity to integrate palliative care in heart failure management.Curr Opin Support Palliat Care. 2009; 3: 247-251
- Early palliative care for patients with metastatic non-small-cell lung cancer.N Engl J Med. 2010; 363: 733-742
Article Info
Footnotes
Drs Swetz and Mueller have received honoraria for speaking from Boston Scientific Education Services; Dr Mueller is a member of the Patient Safety Advisory Board for Boston Scientific.
Identification
Copyright
© 2011 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
