Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis

Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014

“…6,8 The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend palliative care consultation (PCC) before LVAD implantation as PCC is associated with improvements in quality of life, symptom burden, mood, and spiritual well-being in LVAD patients. [9][10][11][12] However, there is scarce data regarding the current degree of palliative care involvement in patients admitted for LVAD implantation. We present a retrospective study of all hospital admissions for LVAD implantation from the Nationwide Inpatient Sample (NIS) database between 2006-2014 to evaluate the trend of palliative care consultation and its predictors.…”

Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions

“…[56][57][58] However, some limitations include potential time constraints, preparedness planning takes significant time, lack of awareness on the part of palliative care providers, and patients' reluctance to discuss these issues. 54,59 At our institution, we have developed a semistructured script as part of our mandatory pre-VAD palliative care consultation (Table 1). It focuses on what is a meaningful life and the underlying values and goals of the patient rather than the specific medical intervention.…”

Palliative Care Consultation Before Left Ventricular Assist Device Implantation

“…In a recent article published in the Journal of Pain and Symptom Management, Chuzi et al 1 report on palliative care (PC) consultations before left ventricular assist device (LVAD) implantation. The authors conclude that a one-time PC consultation immediately before implantation is insufficient to complete preparedness planning and to delineate patients' preferences and goals.…”

“…As we have noticed with advance directives, it is difficult for patients to understand the specific interventions (e.g., mechanical ventilation, renal replacement therapy, or blood transfusions) in the inherently more complex medical state when they need to make such decisions. 3 Furthermore, as shown by the authors, 1 it would be even more overwhelming for patients in that emotionally charged situation to consider the possibility of device malfunction or other progressive comorbid condition, such as old age or malignancy. Regardless of the reason of deterioration, such as LVAD-associated complications, device malfunctions, or progressive complications, decisions about the goals of care would ultimately come down to the patients' attitudes toward his/her quality of life, beliefs about suffering, tradeoffs, and what is an unacceptable state; and this is inherently subjective and unique to the specific patient.…”

“…A major challenge to implementing ''preparedness planning'' before VAD is that it is not entirely clear what this type of planning should entail and which members of the VAD care team should perform it. Swetz et al 1 have outlined four major components of preparedness planning, which are discussions of 1) possible device failure, 2) post-VAD health-related quality of life, 3) device complications, and 4) progressive comorbid conditions. We analyzed our PC notes for documents of these elements of preparedness planning.…”