Effectiveness of an Intervention Supporting Shared Decision Making for Destination Therapy Left Ventricular Assist Device

Allen, Larry A.; McIlvennan, Colleen K.; Thompson, Jocelyn S.; Dunlay, Shannon M.; LaRue, Shane J.; Lewis, Eldrin F.; Patel, Chetan B.; Blue, Laura; Fairclough, Diane L.; Leister, Erin; Glasgow, Russell E.; Cleveland, Joseph C.; Phillips, Clifford; Baldridge, Vicie; Walsh, Mary Norine; Matlock, Daniel D.

doi:10.1001/jamainternmed.2017.8713

Cited by 149 publications

(128 citation statements)

References 51 publications

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“…Early referral applies to a wide spectrum of patients ranging from housebound NYHA class IV patients with poor exercise capacity despite optimal medical treatment plus CRT if needed, to NYHA class IV patients who are refractory to conventional treatments. Shared decision making is an important component of determining the appropriateness of long‐term MCS …”

Section: Management Strategies For Patients With Advanced Heart Failurementioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

677

605

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This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.

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Section: Management Strategies For Patients With Advanced Heart Failurementioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

677

605

View full text Add to dashboard Cite

show abstract

“…There have been other clinical trials of decision aids for cardiovascular care since 2015, for example DECIDE‐LVAD . There are also decision aids that can be helpful but have not necessarily been studied in clinical trials.…”

Section: Decision Aidsmentioning

confidence: 99%

“…48 There have been other clinical trials of decision aids for cardiovascular care since 2015, for example DECIDE-LVAD. 49 There are also decision aids that can be helpful but have not necessarily been studied in clinical trials. The American College of Cardiology's CardioSmart website, for example, provides several decision aids covering the management of atrial fibrillation, aortic stenosis, and heart failure.…”

Section: Decision Aidsmentioning

confidence: 99%

Shared decision‐making for older adults with cardiovascular disease

Backman

Levine

Wenger

et al. 2019

Clinical Cardiology

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Shared decision‐making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision‐making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision‐making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision‐making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.

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“…In a correlative study of 359 randomized patients employing destination therapy LVAD reading materials and patient video decision aids, Allen and colleagues found statistically significant correlations between patient‐stated values and caregiver‐reported treatment choices (difference in Kendall's tau: 0.36, P = .03). They also found decreased caregiver‐reported decisional conflict …”

Section: Palliative Care In Cardiology: Outcomesmentioning

confidence: 99%

Palliative cardiovascular care: The right patient at the right time

Sullivan

Kirkpatrick

2019

Clinical Cardiology

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In the increasingly complex world of modern medicine, relationship‐centered, team‐based care is important in geriatric cardiology. Palliative cardiovascular care plays a central role in defining the scope and timing of medical therapies and in coordinating symptom‐targeted care in line with patient wishes, values, and preferences. Palliative care addresses advance care planning, symptom relief and caregiver/family support and seeks to ameliorate all forms of suffering, including physical, psychological, and spiritual. Although palliative care grew out of the hospice movement and has traditionally been associated with care at the end of life, the current model acknowledges that palliative care can be delivered concurrent with invasive, life‐prolonging interventions. As the population ages, patients with serious cardiovascular disease increasingly suffer from noncardiac, multimorbid conditions and become eligible for interventions that palliate symptoms but also prolong life. Management of implanted cardiac support devices at the end of life, whether rhythm management devices or mechanical circulatory support devices, can involve a host of complexities in decisions to deactivate, timing of deactivation and even the mechanics of deactivation. Studies on palliative care interventions have demonstrated clear improvements in quality of life and are more mixed on life prolongation and cost savings. There is and will remain a dearth of clinicians with specialist palliative care training. Therefore, cardiovascular clinicians have a role to play in provision of practical, “primary” palliative care.

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Effectiveness of an Intervention Supporting Shared Decision Making for Destination Therapy Left Ventricular Assist Device

Cited by 149 publications

References 51 publications

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Shared decision‐making for older adults with cardiovascular disease

Palliative cardiovascular care: The right patient at the right time

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