Palliative Care and End-of-Life Issues in Patients Treated With Left Ventricular Assist Devices as Destination Therapy
Swetz, Keith M
Ottenberg, Abigale L
Freeman, Monica R
Mueller, Paul S
Current heart failure reports 2011 Sep; 8(3): 212-8
Left ventricular assist devices as destination therapy (DT) improve quality of life for many patients with advanced heart failure. However, DT can be associated with risks such as infection, bleeding, and stroke, and may impose psychosocial strain on patients and caregivers. Furthermore, patients treated with DT eventually will die with their device in place whether death is related to the device or not. In response to these concerns, palliative medicine consultation has been suggested with standard DT care to improve focus on quality of life, symptom management, and end-of-life planning. This article reviews key issues associated with caring for patients with DT, including psychosocial, quality-of-life, caregiving, and ethical issues, and discusses end-of-life management of patients with DT, including practical considerations, but moreover, review topics regarding communication, symptom management, and provision of appropriate comfort care.
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Palliative Medicine Consultation for Preparedness Planning in Patients Receiving Left Ventricular Assist Devices as Destination Therapy Swetz, Keith M; Freeman, Monica R; AbouEzzeddine, Omar F; Carter, Kari A; Boilson, Barry A; Ottenberg, Abigale L; Park, Soon J; Mueller, Paul S (2011-06)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).
Swetz, Keith M; Mueller, Paul S; Ottenberg, Abigale L; Dib, Chadi; Freeman, Monica R; Sulmasy, Daniel P (2011-02)Patients who undergo implantation of left ventricular assist devices (LVADs) often have improved quality of life, but may eventually succumb to their heart failure and/or sustain LVAD-related complications. In end-of-life ...
Mueller, Paul S; Swetz, Keith M; Freeman, Monica R; Carter, Kari A; Crowley, Mary Eliot; Severson, Cathy J Anderson; Park, Soon J; Sulmasy, Daniel P (2010-09)To describe a series of patients with heart failure supported with a ventricular assist device (VAD) who requested (or whose surrogates requested) withdrawal of VAD support and the legal and ethical aspects pertaining to ...