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Tenge T, Shahinzad S, Meier S, Schallenburger M, Batzler YN, Schwartz J, Coym A, Rosenbruch J, Tewes M, Simon ST, Roch C, Hiby U, Jung C, Boeken U, Gaertner J, Neukirchen M. Multicenter exploration of specialist palliative care in patients with left ventricular assist devices - a retrospective study. BMC Palliat Care 2024; 23:229. [PMID: 39313780 PMCID: PMC11421205 DOI: 10.1186/s12904-024-01563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 09/16/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients. METHODS We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included. RESULTS In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3-50.3 months). Median duration between consultation and death was seven days (IQR 3-28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p < 0.001; DNR before: n = 20, after: n = 28, p < 0.001). Symptom burden as assessed at first specialist palliative care contact was higher compared to the consultation requests (request: median 3 symptoms (IQR 3-6); first contact: median 9 (IQR 6-10); p < 0.001) with a focus on weakness, anxiety, overburdening of next-of-kin and dyspnea. More than 70% of patients died during index hospitalization, one third of these in a palliative care unit. CONCLUSIONS This largest European multicenter investigation of LVAD-patients receiving specialist palliative care shows a late integration and high physical and psychosocial symptom burden. This study highlights the urgent need for earlier integration to identify and address poorly controlled symptoms. Further studies and educational efforts are needed to close the gap between guideline-recommendations and the current status quo.
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Affiliation(s)
- Theresa Tenge
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Shaylin Shahinzad
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Stefan Meier
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Manuela Schallenburger
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Yann-Nicolas Batzler
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany.
| | - Anja Coym
- Palliative Care Unit, Department of Oncology, Hematology and Bone Marrow Transplant, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Rosenbruch
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf CIO ABCD, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Carmen Roch
- Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, Würzburg, Germany
| | - Ute Hiby
- RHÖN-Klinikum AG, Campus Bad Neustadt, Bad Neustadt an Der Saale, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Jan Gaertner
- Palliative Care Center Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Martin Neukirchen
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany
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DiMauro PK. Clinical Recommendations for Improving Palliative Nursing Care for Patients With a Left Ventricular Assist Device. J Hosp Palliat Nurs 2024; 26:231-237. [PMID: 38885421 DOI: 10.1097/njh.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Nurses who care for patients with a left ventricular assist device (LVAD) are highly skilled clinicians who manage unique technological demands and complex complications within this specialized patient population. There is a demonstrated need and benefit for palliative care for patients with a LVAD, yet palliative consults are often underused, and the quality of consultation for these patients is poorly understood. Rarely, if at all, do nurses receive formal training on how to navigate the palliative care needs of patients with a LVAD, which includes preparedness planning, caregiver support, device/body image acceptance, and end-of-life care. In addition, there is a need for literature to address specifically how nurses in their role and scope of practice can improve palliative care for patients with a LVAD. The purpose of this article was to present recommendations to equip palliative care nurses to best serve the needs of patients with a LVAD, wherein they can partner with and advance their colleagues in cardiology to improve their delivery of primary palliative care.
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Affiliation(s)
- Pierce K DiMauro
- Pierce K. DiMauro, MSN, RN, is DNP candidate and palliative care DNP fellow, Columbia University School of Nursing, New York, NY
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3
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Wan S, Chen Y, Yuan X, Lin Y. Postoperative care of 14 patients with left ventricular assist devices: a case series. J Int Med Res 2024; 52:3000605231214943. [PMID: 38318647 PMCID: PMC10846282 DOI: 10.1177/03000605231214943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/30/2023] [Indexed: 02/07/2024] Open
Abstract
A left ventricular assist device is a mechanical device that is surgically implanted in the heart to partially or completely replace the function of the heart. Left ventricular assist devices are of vital importance in the treatment of patients with heart failure. There are different recommendations for the postoperative care of patients undergoing left ventricular assist device implantation in different countries, and no uniform standard has been developed. The first implantation of a left ventricular assist device in Eastern China was performed in February 2021; since that date, 14 patients underwent implantation until February 2023. This report describes the postoperative care of these 14 patients with end-stage heart failure who underwent left ventricular assist device placement, all of whom were discharged with a good prognosis.
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Affiliation(s)
| | | | - Xia Yuan
- Nursing Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Lin
- Nursing Department, Zhongshan Hospital, Fudan University, Shanghai, China
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4
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Yousefi H, Bagheri I, Bahrami M, Shafie D. Adaptation of interdisciplinary clinical practice guidelines to palliative care for patients with heart failure in iran: application of adapte method. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:92-98. [DOI: 10.4103/ijnmr.ijnmr_152_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 10/23/2022] [Indexed: 01/26/2023]
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Hentsch L, Sobanski PZ, Escher M, Pautex S, Meyer P. Palliative care provision for people living with heart failure: The Geneva model. Front Cardiovasc Med 2022; 9:933977. [PMID: 36093153 PMCID: PMC9452732 DOI: 10.3389/fcvm.2022.933977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
As life expectancy rises and the survival rate after acute cardiovascular events improves, the number of people living and dying with chronic heart failure is increasing. People suffering from chronic ischemic and non-ischemic heart disease may experience a significant limitation of their quality of life which can be addressed by palliative care. Although international guidelines recommend the implementation of integrated palliative care for patients with heart failure, models of care are scarce and are often limited to patients at the end of life. In this paper, we describe the implementation of a model designed to improve the early integration of palliative care for patients with heart failure. This model has enabled patients to access palliative care when they normally would not have and given them the opportunity to plan their care in line with their values and preferences. However, the effectiveness of this interdisciplinary model of care on patients' quality of life and symptom burden still requires evaluation.
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Affiliation(s)
- Lisa Hentsch
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Piotr Z. Sobanski
- Palliative Care Unit and Competence Center, Department of Internal Disease, Schwyz Hospital, Schwyz, Switzerland
| | - Monica Escher
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
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6
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Hollander SA, Kaufman BD, Bui C, Gregori B, Murray JM, Sacks L, Ryan KR, Ma M, Rosenthal DN, Char D. Compassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases. J Pain Symptom Manage 2021; 62:523-528. [PMID: 33910026 DOI: 10.1016/j.jpainsymman.2021.01.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Compassionate deactivation (CD) of ventricular assist device (VAD) support is a recognized option for children when the burden of therapy outweighs the benefits. OBJECTIVES To describe the prevalence, indications, and outcomes of CD of children supported by VADs at the end of life. METHODS Review of cases of CD at our institution between 2011 and 2020. To distinguish CD from other situations where VAD support is discontinued, patients were excluded from the study if they died during resuscitation (including extracorporeal membrane oxygenation), experienced brain or circulatory death prior to deactivation, or experienced a non-survivable brain injury likely to result in imminent death regardless of VAD status. RESULTS Of 24 deaths on VAD, 14 (58%) were CD. Median age was 5.7 (interquartile range (IQR) 0.6, 11.6) years; 6 (43%) had congenital heart disease; 4 (29%) were on a device that can be used outside of the hospital. CD occurred after 40 (IQR: 26, 75) days of support; none while active transplant candidates. CD discussions were initiated by the caregiver in 6 (43%) cases, with the remainder initiated by a medical provider. Reasons for CD were multifactorial, including end-organ injury, infection, and stroke. CD occurred with endotracheal extubation and/or discontinuation of inotropes in 12 (86%) cases, and death occurred within 10 (IQR: 4, 23) minutes of CD. CONCLUSION CD is the mode of death in more than half of our VAD non-survivors and is pursued for reasons primarily related to noncardiac events. Caregivers and providers both initiate CD discussions. Ventilatory and inotropic support is often withdrawn at time of CD with ensuing death.
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Affiliation(s)
- Seth A Hollander
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA.
| | - Beth D Kaufman
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Christine Bui
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Bianca Gregori
- Department of Social Work, Lucile Packard Children's Hospital Stanford (B.G.), Palo Alto, California, USA
| | - Jenna M Murray
- Solid Organ Transplant Services, Lucile Packard Children's Hospital Stanford (J.M.M), Palo Alto, California, USA
| | - Loren Sacks
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Kathleen R Ryan
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine (M.M.), Palo Alto, California, USA
| | - David N Rosenthal
- Department of Pediatrics (Cardiology), Stanford University School of Medicine (S.A.H., B.D.K., C.B., L.S., K.R.R., D.N.R.), Palo Alto, California, USA
| | - Danton Char
- Department of Anesthesia, Stanford University School of Medicine (D.C.), Palo Alto, California, USA
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Årestedt K, Brännström M, Evangelista LS, Strömberg A, Alvariza A. Palliative key aspects are of importance for symptom relief during the last week of life in patients with heart failure. ESC Heart Fail 2021; 8:2202-2209. [PMID: 33754461 PMCID: PMC8120384 DOI: 10.1002/ehf2.13312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 01/05/2023] Open
Abstract
AIMS This study aimed to describe symptom prevalence of pain, shortness of breath, anxiety, and nausea and to identify factors associated with symptom relief in patients with heart failure during their last week of life. METHODS AND RESULTS This nationwide study used data from the Swedish Register of Palliative Care and the Swedish Causes of Death Certificate Register. The sample included 4215 patients with heart failure as the underlying cause of death. Descriptive statistics and logistic regression were used to analyse data. Pain was the most prevalent symptom (64.0%), followed by anxiety (45.1%), shortness of breath (28.8%), and nausea (11.4%). Pain was the most often totally relieved (77.5%), followed by anxiety (68.4%), nausea (54.7%), and shortness of breath (37.1%). Key aspects of palliative care such as documented palliative care in the patient record, individual medication prescriptions by injection, symptom assessment with validated scales, documented end-of-life discussions with patients and/or family members, and external consultation were significantly associated with symptom relief. Relief of pain, shortness of breath, anxiety, and nausea were significantly better managed in nursing homes and hospice/inpatient palliative care compared with care in hospitals. CONCLUSIONS The results show that key aspects of palliative care during the last week of life are significantly associated with symptom relief. Increased access to palliative care could provide a way to improve care during the last week of life for patients with heart failure. Home-based settings provided more symptom relief than hospitals, which may indicate that the latter focuses on treatments and saving lives rather than promoting life before death.
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Affiliation(s)
- Kristofer Årestedt
- Faculty of Health and Life SciencesLinnaeus UniversityKalmarSE‐39182Sweden
- The Research SectionKalmar County CouncilKalmarSweden
| | | | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of CardiologyLinköping UniversityLinköpingSweden
- Department of CardiologyLinköping UniversityLinköpingSweden
| | - Anette Alvariza
- Department of Health Care Sciences & Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
- Capio Palliative CareDalen HospitalStockholmSweden
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Pandey D, Mahmood A, Harounian J, Fleming-Damon C, Mencias M, Portenoy RK, Knotkova H. Providing End-of-Life Care for Patients With Left Ventricular Assist Devices: Experience of a Hospice Agency. J Pain Symptom Manage 2021; 61:891-897. [PMID: 33059016 DOI: 10.1016/j.jpainsymman.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Patients with left ventricular assist devices (LVADs) need expert palliative care at the end of life. In the U.S., hospice may provide this care, but few patients enroll, and information about hospice experience with LVAD-implanted patients is limited. OBJECTIVE To describe hospice experience with LVAD-implanted patients. METHODS This is a retrospective descriptive study of all LVAD-implanted patients admitted to a hospice agency. Data were extracted from the electronic health record. RESULTS The 13 patients had a mean age of 63 years (range 20-89) and a mean LVAD duration of 32.5 months (range 8.2-70.0). Hospice diagnosis was heart failure in 10 patients and cancer in three patients; all patients were multimorbid. Eight patients enrolled in hospice on one occasion, four had two enrollments, and one had five. All patients received services for <180 days, three for <7 days, and four patients for >90 days. Just-in-time inservicing was used to prepare hospice teams for challenging care needs, including bleeding, delirium, infections, and mechanical failure. Of the nine patients who died while receiving hospice services, one enrolled with a plan to deactivate the LVAD immediately after hospice enrollment, and six died after discontinuation of the LVAD or other life-sustaining therapy during the course of hospice care. Five deaths occurred in a hospice inpatient unit. CONCLUSION To provide specialist palliative care to LVAD-implanted patients, hospices must be prepared to manage complex and highly varied needs. To do this, hospices must have adequate staff support and access to acute care.
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Affiliation(s)
- Deepali Pandey
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Ashraf Mahmood
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Joshua Harounian
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Colleen Fleming-Damon
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; MJHS Hospice and Palliative Care, New York, New York, USA
| | | | - Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; MJHS Hospice and Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, New York, USA; Department of Neurology, Albert Einstein College of Medicine, The Bronx, New York, USA
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, New York, USA.
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9
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Tenge T, Schlieper D, Schallenburger M, Meier S, Schwartz J, Neukirchen M. [Palliative care in patients with left ventricular assist devices: systematic review]. Anaesthesist 2021; 70:1044-1050. [PMID: 33931802 PMCID: PMC8639546 DOI: 10.1007/s00101-021-00967-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
Hintergrund Bei terminal herzinsuffizienten Patienten gewinnt die Implantation von Linksherzunterstützungssystemen (LVAD) als Therapieoption zunehmend an Bedeutung. Diese Systeme werden als Überbrückung bis zu einer Herztransplantation (BTT) oder als definitive Therapie (DT) eingesetzt. Sie können die Lebensqualität verbessern und die Lebenszeit verlängern. Trotzdem bleibt die Prognose besonders bei DT oder bei Wechsel von BTT zu DT mit Blick auf die Lebenszeit und auftretende Komplikationen ungünstig. Bisher ist ungeklärt, ob eine LVAD-Implantation eine Indikation für eine frühzeitige Integration von Palliativmedizin darstellt. Ziel der Arbeit Erfassung der aktuellen Studienlage über den Einfluss einer palliativmedizinischen Behandlung bei LVAD-Patienten. Material und Methoden Im Mai 2020 wurde eine systematische Literaturrecherche in 6 verschiedenen Datenbanken durchgeführt. Ergebnisse Von den 491 Treffern der Literaturrecherche wurden 21 Arbeiten in diese Übersichtsarbeit eingeschlossen. Durch die frühzeitige Integration der Palliativmedizin vor LVAD-Implantation erhöhte sich die Anzahl der Patienten mit vorausschauender Versorgungsplanung und Vorsorgeinstrumenten. Außerdem zeigte sich ein positiver Einfluss auf das familiäre Umfeld, das Symptommanagement und die Umstände des Versterbens. Es gibt verschiedene Formate für die Integration palliativmedizinischer Konzepte in die LVAD-Therapie. Diskussion Die frühzeitige und kontinuierliche Einbindung der Palliativmedizin im Verlauf einer LVAD-Therapie kann die Behandlungsqualität verbessern. Die Ausarbeitung von spezifischen Handlungsempfehlungen ist in Abhängigkeit vom Therapieziel (BTT oder DT) sinnvoll. Empfohlen werden Schulungen für Palliativmediziner und LVAD-Spezialisten.
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Affiliation(s)
- T Tenge
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - D Schlieper
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - M Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - S Meier
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland.
| | - J Schwartz
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - M Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland.,Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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10
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Thompson JH, Moser D. Experiences with end-of-life care with a left ventricular assist device: An integrative review. Heart Lung 2020; 49:451-457. [DOI: 10.1016/j.hrtlng.2020.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
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Gerlach MSc C, Weber M. The Importance of Palliative Counseling. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:268. [PMID: 32449890 PMCID: PMC7268093 DOI: 10.3238/arztebl.2020.0268a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Christina Gerlach MSc
- *Interdisziplinäre Abteilung für Palliativmedizin, III. Medizinische Klinik Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Martin Weber
- *Interdisziplinäre Abteilung für Palliativmedizin, III. Medizinische Klinik Universitätsmedizin der Johannes Gutenberg-Universität Mainz
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