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Januszkiewicz Ł, Barra S, Marijon E, Providencia R, de Asmundis C, Chun JKR, Farkowski MM, Conte G, Boveda S. Major gaps in the information provided to patients before implantation of cardioverter defibrillators: a prospective patient European evaluation. Europace 2023; 25:1144-1151. [PMID: 36691111 PMCID: PMC10062348 DOI: 10.1093/europace/euac275] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS Information provided to patients prior to implantable cardioverter-defibrillator (ICD) insertion and their participation in the decision-making process are crucial for understanding ICD function and accepting this lifelong therapy. The aim of this study is to evaluate the extent to which different aspects related to ICD and quality of life were transmitted to patients prior to ICD implantation. METHODS AND RESULTS Prospective, multicenter European study with an online questionnaire initiated by the European Heart Rhythm Association. The questionnaire was filled-in directly and personally by the ICD patients who were invited to participate. A total of 1809 patients (majority in their 40s-70s, with 624 women, 34.5%) from 10 European countries participated in the study. The median time from first ICD implantation was 5 years (interquartile range 2-10). Overall, 1155 patients (71.5%) felt optimally informed at the time of device implantation, however many respondents received no information about ICD-related complications (n = 801, 49.6%), driving restrictions (n = 718, 44.5%), and possibility of end-of-life ICD deactivation (n = 408, 25.4%). Of note, women were less frequently involved in the decision-making process than men (47.3% vs. 55.9%, P = 0.003) and reported to be less often optimally informed before ICD implantation than men (61.2% vs. 76.8%, P < 0.001). More women mentioned the desire to have learned more about ICD therapy and the benefit/risk balance (45.4% vs. 33.7% of men; P < 0.001). CONCLUSIONS This patient-based evaluation provides alarming findings on the lack of information provided to patients prior ICD implantation, particularly for women.
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Affiliation(s)
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
| | - Eloi Marijon
- University of Paris, Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris Cardiovascular Research Center, INSERM Unit 970, 56 Rue Leblanc, 75015, Paris, France
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Institute of Health Informatics Research, University College London, London, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Michał M Farkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Paris Cardiovascular Research Center, INSERM Unit 970, 56 Rue Leblanc, 75015, Paris, France
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Callaghan EM, Diamandis-Nikoletatos E, van Leeuwen PP, Higgins JB, Somerville CE, Brown LJ, Schumacher TL. Communication regarding the deactivation of implantable cardioverter-defibrillators: A scoping review and narrative summary of current interventions. PATIENT EDUCATION AND COUNSELING 2022; 105:3431-3445. [PMID: 36055906 DOI: 10.1016/j.pec.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Communication about deactivation of implantable cardioverter-defibrillator (ICD) therapy at end-of-life (EoL) is a recognised issue within clinical practice. The aim of this scoping review was to explore and map the current literature in this field, with a focus on papers which implemented interventional studies. METHODS Systematic searches of six major databases were conducted. Citations were included by four researchers according to selection criteria. Key demographic data and prespecified themes in relation to communication of ICD deactivation at EoL were extracted. RESULTS The search found 6197 texts of which 63 were included: 39 quantitative, 14 qualitative and 10 mixed-methods. Surveys were predominantly used to gather data (n = 34), followed by interviews (n = 18) and retrospective reviews of patient records (n = 18). CONCLUSIONS Several key gaps in the literature warrant further research. These include who is responsible for initiating ICD deactivation discussions, how clinicians should initiate and conduct these discussions, when ICD deactivations should be occurring, and family perspectives. Adequately explored themes include patient and clinician knowledge and attitudes regarding ICD deactivation at EoL. PRACTICAL IMPLICATIONS Facilities treating patients with ICDs at EoL should consider ongoing quality improvement projects aimed at clinician education and protocol changes to improve communication surrounding EoL ICD deactivation.
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Affiliation(s)
- Ellen M Callaghan
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | - Elly Diamandis-Nikoletatos
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | - Paul P van Leeuwen
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | - Jack B Higgins
- School of Medicine and Public Health (Joint Medical Program), University of Newcastle, Callaghan, NSW 2305, Australia; School of Rural Medicine (Joint Medical Program), University of New England, Armidale, NSW 2350, Australia
| | | | - Leanne J Brown
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tracy L Schumacher
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Tamworth, NSW 2340, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.
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Wang S, Lu Q, Ye Z, Liu F, Yang N, Pan Z, Li Y, Li L. Effects of a smartphone application named "Shared Decision Making Assistant" for informed patients with primary liver cancer in decision-making in China: a quasi-experimental study. BMC Med Inform Decis Mak 2022; 22:145. [PMID: 35641979 PMCID: PMC9152304 DOI: 10.1186/s12911-022-01883-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/16/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is well known that decision aids can promote patients' participation in decision-making, increase patients' decision preparation and reduce decision conflict. The goal of this study is to explore the effects of a "Shared Decision Making Assistant" smartphone application on the decision-making of informed patients with Primary Liver Cancer (PLC) in China. METHODS In this quasi-experimental study , 180 PLC patients who knew their real diagnoses in the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China, from April to December 2020 were randomly assigned to a control group and an intervention group. Patients in the intervention group had an access to the "Shared Decision Making Assistant" application in decision-making, which included primary liver cancer treatment knowledge, decision aids path, continuing nursing care video clips, latest information browsing and interactive platforms. The study used decision conflict scores to evaluate the primary outcome, and the data of decision preparation, decision self-efficacy, decision satisfaction and regret, and knowledge of PLC treatment for secondary outcomes. Then, the data were entered into the SPSS 22.0 software and were analyzed by descriptive statistics, Chi-square, independent t-test, paired t-test, and Mann-Whitney tests. RESULTS Informed PLC patients in the intervention group ("SDM Assistant" group) had significantly lower decision conflict scores than those in the control group. ("SDM Assistant" group: 16.89 ± 8.80 vs. control group: 26.75 ± 9.79, P < 0.05). Meanwhile, the decision preparation score (80.73 ± 8.16), decision self-efficacy score (87.75 ± 6.87), decision satisfaction score (25.68 ± 2.10) and knowledge of PLC treatment score (14.52 ± 1.91) of the intervention group were significantly higher than those of the control group patients (P < 0.05) at the end of the study. However, the scores of "regret of decision making" between the two groups had no statistical significance after 3 months (P > 0.05). CONCLUSIONS Access to the "Shared Decision Making Assistant" enhanced the PLC patients' performance and improved their quality of decision making in the areas of decision conflict, decision preparation, decision self-efficacy, knowledge of PLC treatment and satisfaction. Therefore, we recommend promoting and updating the "Shared Decision Making Assistant" in clinical employment and future studies.
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Affiliation(s)
- Sitong Wang
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.,Officers' Ward, General Hospital of Northern Theater Command, Shenyang, 110016, Liaoning, People's Republic of China
| | - Qingwen Lu
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Zhixia Ye
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Fang Liu
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Ning Yang
- Department of No. 5 Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Zeya Pan
- Department of No. 3 Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Yu Li
- Department of Organ Transplantation, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Li Li
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.
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Lee KS, Oh O, Miller J, Hammash M, Thompson DR, Ski CF, Cameron J, Hwang SY, Moser DK. Patients' openness to discussing implantable cardioverter defibrillator deactivation at end of life: a cross-sectional study. Eur J Cardiovasc Nurs 2022; 21:687-693. [PMID: 35018427 DOI: 10.1093/eurjcn/zvab130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/14/2022]
Abstract
AIMS It is recommended that patients and clinicians discuss end-of-life deactivation of their implantable cardioverter defibrillator (ICD) prior to device implantation and throughout the illness trajectory to facilitate shared decision-making. However, such discussions rarely occur, and little is known about patients' openness to this discussion. The purpose of this study was to explore factors associated with patients' openness to discussing end-of-life ICD deactivation with clinicians. METHODS AND RESULTS This cross-sectional study recruited 293 patients with an ICD from outpatient clinics in the USA, Australia, and South Korea. Patients were classified into an open or resistant group based on their desire to discuss device deactivation at end of life with clinicians. Multivariable logistic regression was used to explore factors related to patients' openness to this discussion.About half of the participants (57.7%) were open to discussing such issues with their clinicians. Factors related to patients' openness to discussing device deactivation at end of life were living with someone, not having severe comorbid conditions (cancer and/or chronic kidney disease), greater ICD knowledge, and more experience discussing end-of-life issues with clinicians (odds ratio: 0.479, 0.382, 1.172, 1.332, respectively). CONCLUSION Approximately half of the ICD recipients were reluctant to discuss device deactivation at end of life with clinicians. Unmodifiable factors were their living arrangement and severe comorbidity. ICD knowledge and prior experience discussing end-of-life issues were potentially modifiable factors in the future. These factors should be addressed when assessing patients' readiness for a shared discussion about device deactivation at end of life.
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Affiliation(s)
- Kyoung Suk Lee
- College of Nursing, Seoul National University, 103 Daehak-ro, Jong-ro, Seoul 03080, South Korea
| | - Oonjee Oh
- College of Nursing, Seoul National University, 103 Daehak-ro, Jong-ro, Seoul 03080, South Korea
| | - Jennifer Miller
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast 97 Lisburn Rd, Belfast BT9 7BL, UK
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, 19 Neptune Quay, Ipswich IP4 1QJ, UK
| | - Jan Cameron
- School of Clinical Sciences at Monash Health, Monash University, 27-31 Wright Street, Clayton VIC 3168, Australia
| | - Seon Young Hwang
- College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
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Wallace BC, Jones J, Masoudi FA, Nowels CT, Varosy P, Thomson R, Elwyn G, Brega AG, Vermilye T, Knoepke CE, Sandhu A, Allen LA, Matlock DD. Development and piloting of four decision aids for implantable cardioverter-defibrillators in different media formats. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1842-1852. [PMID: 34528271 DOI: 10.1111/pace.14365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/28/2021] [Accepted: 09/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Using DAs for preference-sensitive decisions is an evidence-based way to improve patient-centered decisions. Reimbursement mandates have increased the need for DAs in ICD care, although none have been formally evaluated. The objectives were to develop and pilot implantable cardioverter-defibrillator (ICD) decision aids (DAs) for patients considering primary prevention ICDs. METHODS Development Phase: An expert panel, including patients and physicians, iteratively developed four DAs: a one-page Option GridTM conversation aid, a four-page in-depth paper tool, a 17-minute video, and an interactive website. Trial Phase: At three sites, patients with heart failure who were eligible for primary prevention ICDs were randomly assigned 2:1 to intervention (received DAs) or control (usual care). We conducted a mixed-methods evaluation exploring acceptability and feasibility. RESULTS Twenty-one eligible patients enrolled (15 intervention). Most intervention participants found the DAs to be unbiased (67%), helpful (89%), and would recommend them to others (100%). The pilot was feasible at all sites; however, using clinic staff to identify eligible patients was more efficient than chart review. Although the main goals were to measure acceptability and feasibility, intervention participants trended towards increased concordance between longevity values and ICD decisions (71% concordant vs. 29%, p = .06). Participants preferred the in-depth paper tool and video DAs. Access to a nurse during the decision-making window encouraged questions and improved participant-perceived confidence. CONCLUSIONS Participants felt the DAs provided helpful, balanced information that they would recommend to other patients. Further exploration of this larger context of DA use and strategies to promote independent use related to electrophysiology (EP) visits are needed.
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Affiliation(s)
- Bryan C Wallace
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frederick A Masoudi
- Ascension Health, St Louis MO.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Carolyn T Nowels
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul Varosy
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA.,Cardiology Section, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, UK
| | - Glyn Elwyn
- Coproduction Laboratory, Dartmouth Institute, Lebanon, New Hampshire, USA
| | - Angela G Brega
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Travis Vermilye
- Department of Visual Arts, University of Colorado Denver, Denver, Colorado, USA
| | - Christopher E Knoepke
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amneet Sandhu
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado, USA
| | - Larry A Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA.,Advanced Heart Failure and Transplantation, Division of Cardiology, and Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, Colorado, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado, USA.,Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Freemantle M, Murtagh F. Implantable cardioverter defibrillator devices: when, how and who should discuss deactivation with patients: a systematic literature review. BMJ Support Palliat Care 2021; 12:359-367. [PMID: 33963003 DOI: 10.1136/bmjspcare-2021-002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are used to treat life-threatening cardiac arrhythmias and prevent sudden cardiac arrest. As recipients age they may develop greater risk of dying as a result of progressive multimorbidity rather than sudden cardiac death. Defibrillation shocks may prolong an uncomfortable dying process. Deactivation of the defibrillator would prevent this, yet is not always discussed and planned. AIM To systematically review published evidence on ICD deactivation discussions and make recommendations on when, how and who should facilitate effective and patient-centred deactivation discussions. METHODS Using standard systematic review methods, MEDLINE, EMBASE, CINAHL and PsycInfo were searched for studies published in the English language between 2010 and March 2021. Inclusion criteria were studies of adults (≥18 years) and including discussions on ICD deactivation and/or related communication. Included studies were independently reviewed, data extracted, quality assessed and data synthesised using a deductive approach. RESULTS Of the 8893 articles identified, 22 papers met the inclusion criteria. Deductive approach led to identification of five main themes: (1) timing of ICD deactivation discussions, (2) initiation of deactivation discussions, (3) advance directives, (4) barriers to discussions and (5) facilitators of discussions. CONCLUSIONS Despite available guidelines, conversations on device deactivation are not being undertaken consistently. Evidence suggests lack of professional awareness of guidelines and limited training in communication skills. To prevent distress and promote comfortable dying, there needs to be a proactive clinical and policy initiative in the education of both professionals and patients and their relatives about device deactivation.
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Affiliation(s)
- Megan Freemantle
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients: clinical considerations and the importance of shared decision-making. Neth Heart J 2021; 29:243-252. [PMID: 33710494 PMCID: PMC8062634 DOI: 10.1007/s12471-021-01555-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/11/2022] Open
Abstract
Implantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients’ options in this critical phase of their illness.
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Affiliation(s)
- Christopher E Knoepke
- Division of Cardiology (C.E.K.), University of Colorado School of Medicine, Aurora.,Adult & Child Consortium for Outcomes Research & Delivery Science (C.E.K.), University of Colorado School of Medicine, Aurora
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