A Path Forward for Palliative Care in Pulmonary Arterial Hypertension

Sonntag, Elizabeth; Grinnan, Daniel

doi:10.1016/j.chest.2020.09.003

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Transitions off these medications for hospice care confers additional layers of complexity that must be navigated skillfully, with nuanced discussion. 16 At all points in the treatment course, the tradeoffs in terms of quality of life and symptom relief must consider patient lifestyle factors, support network and capacity to absorb and integrate difficult news.…”

Section: Barriers To Effective Serious Illness Conversationsmentioning

confidence: 99%

“…PAH is unique in that withdrawal of prostacyclin medication can result in refractory RV failure, and as such, transparent discussion that goes beyond risks and benefits and considers the emotional toll of being dependent on continuous therapy is warranted. Transitions off these medications for hospice care confers additional layers of complexity that must be navigated skillfully, with nuanced discussion 16 . At all points in the treatment course, the tradeoffs in terms of quality of life and symptom relief must consider patient lifestyle factors, support network and capacity to absorb and integrate difficult news.…”

Section: Barriers To Effective Serious Illness Conversationsmentioning

confidence: 99%

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Serious illness conversations in pulmonary hypertension

et al. 2021

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Pulmonary arterial hypertension has evolved from a fatal disease with few treatment options to a chronic condition with improved survival. This improvement is possible through development of effective therapies as well as the expansion of risk stratification scores to assist clinical decision making. Despite improved disease control, quality of life, and overall prognosis, many challenges remain. The treatment itself is burdensome, with significant impact on quality of life. Many patients with pulmonary arterial hypertension still present with advanced, often end-stage disease. Increased use of mechanical circulatory support and catheter-based interventions have expanded use of extracorporeal life support and right ventricle assist devices.â¯For these reasons as well as the long-term relationships pulmonary hypertension physicians have with patients and their families, navigating the course of the illness in a considered, proactive way is essential. Understanding individual goals and revisiting them as they change over time requires comfort with the conversation itself. There are many barriers and challenges to having effective, compassionate conversations in the clinical setting with time constraints being the most often cited. Compressed visits are necessarily focused on the clinical aspects, therapy and medication adherence and tolerance. Clinicians are sometimes wary of diminishing hope in the face of ongoing treatment. Having sufficient experience and comfort with these discussions can be empowering. In this paper we discuss the challenges involved and propose a framework to assist in incorporating these discussions into clinical care.

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Section: Barriers To Effective Serious Illness Conversationsmentioning

confidence: 99%

Section: Barriers To Effective Serious Illness Conversationsmentioning

confidence: 99%

Serious illness conversations in pulmonary hypertension

et al. 2021

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Palliative Care in Pulmonary Arterial Hypertension

Christiansen

Weatherald

Orlikow

2021

Respiratory Medicine

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Right Heart Failure in the Intensive Care Unit: Etiology, Pathogenesis, Diagnosis, and Treatment

Tarras,

Khosla,

Heerdt

et al. 2023

J Intensive Care Med

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Right heart (RH) failure carries a high rate of morbidity and mortality. Patients who present with RH failure often exhibit complex aberrant cardio-pulmonary physiology with varying presentations. The treatment of RH failure almost always requires care and management from an intensivist. Treatment options for RH failure patients continue to evolve rapidly with multiple options available, including different pharmacotherapies and mechanical circulatory support devices that target various components of the RH circulatory system. An understanding of the normal RH circulatory physiology, treatment, and support options for the RH failure patients is necessary for all intensivists to improve outcomes. The purpose of this review is to provide clinical guidance on the diagnosis and management of RH failure within the intensive care unit setting, and to highlight the different pathophysiological manifestations of RH failure, its hemodynamics, and treatment options available at the disposal of the intensivist.

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A Path Forward for Palliative Care in Pulmonary Arterial Hypertension

Cited by 4 publications

References 10 publications

Serious illness conversations in pulmonary hypertension

Serious illness conversations in pulmonary hypertension

Palliative Care in Pulmonary Arterial Hypertension

Right Heart Failure in the Intensive Care Unit: Etiology, Pathogenesis, Diagnosis, and Treatment

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