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Giffard M, VAN Bulck L, Seydou Sall F, Becoulet N, Quenot JP, Seronde MF, Ecarnot F. Profiles of patients referred to specialized palliative care from the cardiology department at a university hospital: an 11-year longitudinal retrospective study. Panminerva Med 2023; 65:467-472. [PMID: 37212751 DOI: 10.23736/s0031-0808.23.04829-2] [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: 05/23/2023]
Abstract
BACKGROUND Although the majority of patients with cardiovascular diseases (CVD) have a significant symptom burden and progressive course towards the end of life, only a small proportion of patients currently receive palliative care. The current referral practices to palliative care from the cardiology department need to be scrutinized. The current study aimed to examine: 1) the clinical profile; 2) time between referral to palliative care and death; and 3) place of death for CVD patients who were referred to palliative care from a cardiology department. METHODS This retrospective descriptive study included all patients who were referred to the mobile palliative care team from the cardiology unit in the University Hospital of Besançon in France between January 2010 and December 2020. Information was extracted from the medical hospital files. RESULTS A total of 142 patients were included, of whom 135 (95%) died. The mean age at the time of death was 76±14 years. The median time between referral to palliative care and death was 9 days. Most patients had chronic heart failure (54%). A total of 17 patients (13%) died at home. CONCLUSIONS This study showed that referral of patients to palliative care from the cardiology department is suboptimal and a large proportion of patients die in the hospital setting. Further prospective studies are warranted to investigate whether these dispositions correspond to patients' wishes and end-of-life care needs, and should investigate how the integration of palliative care into the care of cardiovascular patients can be improved.
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Affiliation(s)
- Mathilde Giffard
- Mobile Palliative Care Team, University Hospital Besançon, Besançon, France
- Inserm CIC1431, University Hospital Besançon, Besançon, France
| | - Liesbet VAN Bulck
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Fatimata Seydou Sall
- Inserm CIC1431, University Hospital Besançon, Besançon, France
- Department of Cardiology, University Hospital Besançon, Besançon, France
| | - Nicolas Becoulet
- Mobile Palliative Care Team, University Hospital Besançon, Besançon, France
| | - Jean-Pierre Quenot
- Intensive Care Unit, University Hospital Dijon-Bourgogne, Dijon, France
- Inserm CIC1432, module Épidémiologie Clinique (CIC-EC), University Hospital Dijon-Bourgogne, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
| | - Marie-France Seronde
- EA3920, University of Burgundy Franche-Comté, Besançon, France
- Department of Cardiology, University Hospital Besançon, Besançon, France
| | - Fiona Ecarnot
- EA3920, University of Burgundy Franche-Comté, Besançon, France -
- Department of Cardiology, University Hospital Besançon, Besançon, France
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2
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Pelosi C, Kauling RM, Cuypers JAAE, Utens EMWJ, van den Bosch AE, van der Heide A, Legerstee JS, Roos-Hesselink JW. Life expectancy and end-of-life communication in adult patients with congenital heart disease, 40-53 years after surgery. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead067. [PMID: 37457543 PMCID: PMC10342419 DOI: 10.1093/ehjopen/oead067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
Aims Although survival of patients with congenital heart disease (CHD) improved significantly over time, life expectancy is still not normal. We aimed to investigate how adult patients, their partners, and treating cardiologists estimated the individual life expectancy of CHD patients. Furthermore, preferences regarding end-of-life (EOL) communication were investigated. Methods and results In this study, we included 202 patients (age: 50 ± 5) who were operated in childhood (<15 years old) between 1968 and 1980 for one of the following diagnoses: atrial septal defect, ventricular septal defect, pulmonary stenosis, tetralogy of Fallot, or transposition of the great arteries. A specific questionnaire was administered to both the patients and their partners, exploring their perceived life expectancy and EOL wishes. Two cardiologists independently assessed the life expectancy of each patient. Most adults with CHD believed their life expectancy to be normal. However, significant differences were found between estimated life expectancy by the cardiologist and patients (female: P = 0.001, male: P = 0.002) with moderate/severe defects, as well as for males with mild defects (P = 0.011). Regarding EOL communication, 85.1% of the patients reported that they never discussed EOL with a healthcare professional. Compared with patients with mild CHD, significantly more patients with moderate/severe defect discussed EOL with a physician (P = 0.011). The wish to discuss EOL with the cardiologist was reported by 49.3% of the patients and 41.7% of their partners. Conclusion Adult patients, especially with moderate/severe CHD, perceived their life expectancy as normal, whereas cardiologists had a more pessimistic view than their patients. Increased attention is warranted for discussions on life expectancy and EOL to improve patient-tailored care.
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Affiliation(s)
- Chiara Pelosi
- Department of Cardiology, Erasmus MC, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus MC, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Elisabeth M W J Utens
- Academic Center for Child and Adolescent Psychiatry, Levvel, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Wytemaweg 80, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Wytemaweg 80, Rotterdam, The Netherlands
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3
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Van Bulck L, Goossens E, Morin L, Luyckx K, Ombelet F, Willems R, Budts W, De Groote K, De Backer J, Annemans L, Moniotte S, de Hosson M, Marelli A, Moons P. Last year of life of adults with congenital heart diseases: causes of death and patterns of care. Eur Heart J 2022; 43:4483-4492. [PMID: 36030410 PMCID: PMC9637423 DOI: 10.1093/eurheartj/ehac484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Although life expectancy in adults with congenital heart diseases (CHD) has increased dramatically over the past five decades, still a substantial number of patients dies prematurely. To gain understanding in the trajectories of dying in adults with CHD, the last year of life warrants further investigation. Therefore, our study aimed to (i) define the causes of death and (ii) describe the patterns of healthcare utilization in the last year of life of adults with CHD. METHODS AND RESULTS This retrospective mortality follow-back study used healthcare claims and clinical data from BELCODAC, which includes patients with CHD from Belgium. Healthcare utilization comprises cardiovascular procedures, CHD physician contacts, general practitioner visits, hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, and specialist palliative care, and was identified using nomenclature codes. Of the 390 included patients, almost half of the study population (45%) died from a cardiovascular cause. In the last year of life, 87% of patients were hospitalized, 78% of patients had an ED visit, and 19% of patients had an ICU admission. Specialist palliative care was provided to 17% of patients, and to only 4% when looking at the patients with cardiovascular causes of death. CONCLUSIONS There is a high use of intensive and potentially avoidable care at the end of life. This may imply that end-of-life care provision can be improved. Future studies should further examine end-of-life care provision in the light of patient's needs and preferences, and how the healthcare system can adequately respond.
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Affiliation(s)
- Liesbet Van Bulck
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Research Foundation Flanders (FWO), 1000, Brussels, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, 2000, Antwerp, Belgium
| | - Lucas Morin
- Inserm CIC 1431, University Hospital of Besançon, 25000, Besançon, France,Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94800, Villejuif, France
| | - Koen Luyckx
- Department of Psychology and Educational Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium,Unit for Professional Training and Service in the Behavioural Sciences (UNIBS), University of the Free State, 9300, Bloemfontein, South Africa
| | - Fouke Ombelet
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Division of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium,Lab of Neurology, VIB – KU Leuven Centre for Brain and Disease Research, 3000, Leuven, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium,Department of Cardiovascular Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Stéphane Moniotte
- Division of Pediatric and Congenital Cardiology, Department of Paediatrics, Cliniques universitaires Saint-Luc, 1000, Brussels, Belgium
| | - Michèle de Hosson
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Arianne Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, H3A 0G4, Montréal (Quebec), Canada
| | - Philip Moons
- Corresponding author. Tel: +32 16 37 33 15, Fax: +32 16 33 69 70,
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4
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Hansen K, Edwards LA, Yohannes K, Luong R, Lin A, Long J, Halpern-Felsher B, Cohen H, Kaufman BD. Advance Care Planning Preferences for Adolescents With Cardiac Disease. Pediatrics 2022; 149:184391. [PMID: 34984466 DOI: 10.1542/peds.2020-049902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescents with cardiac disease are at risk for life-changing complications and premature death. The importance of advance care planning (ACP) in adults with congenital heart disease and in pediatric patients with HIV and cancer has been demonstrated. ACP preferences of adolescents with heart disease have not been evaluated. We describe ACP preferences of adolescents with heart disease and compare with those of their caregivers. METHODS Outpatient adolescents aged 12 to 18 years with heart failure, cardiomyopathy, heart transplantation, or who were at risk for cardiomyopathy, as well as their caregivers, completed self-administered questionnaires which evaluated participants' opinions regarding content and timing of ACP discussions, preferences for end-of-life communication, and emotional responses to ACP. RESULTS Seventy-eight adolescents and 69 caregivers participated, forming 62 adolescent-caregiver dyads. Adolescents and caregivers reported that adolescent ACP discussions should occur early in the disease course (75% and 61%, respectively). Adolescents (92%) wanted to be told about terminal prognosis, whereas only 43% of caregivers wanted the doctor to tell their child this information. Most adolescents (72%) and caregivers (67%) anticipated that discussing ACP would make the adolescent feel relieved the medical team knew their wishes. Most caregivers (61%) believed that adolescents would feel stress associated with ACP discussions, whereas only 31% of adolescents anticipated this. CONCLUSIONS Adolescents and their caregivers agree that ACP should occur early in disease course. There are discrepancies regarding communication of prognosis and perceived adolescent stress related to ACP discussions. Facilitated conversations between patient, caregiver, and providers may align goals of care and communication preferences.
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Affiliation(s)
| | - Lindsay A Edwards
- Divisions of Cardiology.,Division of Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | | | | | - Amy Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Bonnie Halpern-Felsher
- Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Harvey Cohen
- Division of Hematology/Oncology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
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5
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Constantine A, Condliffe R, Clift P, Tulloh R, Dimopoulos K. Palliative care in pulmonary hypertension associated with congenital heart disease: systematic review and expert opinion. ESC Heart Fail 2021; 8:1901-1914. [PMID: 33660435 PMCID: PMC8120400 DOI: 10.1002/ehf2.13263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Pulmonary arterial hypertension (PAH) is common amongst patients with congenital heart disease (CHD). It is a severe and complex condition that adversely affects quality of life and prognosis. While quality of life questionnaires are routinely used in clinical pulmonary hypertension practice, little is known on how to interpret their results and manage PAH-CHD patients with evidence of impaired health-related quality of life, especially those with advanced disease and palliative care needs. METHODS AND RESULTS We performed a systematic review of studies concerning palliative care for people with PAH-CHD, also reviewing the health-related quality of life literature pertaining to these patients. Of 330 papers identified through initial screening, 17 were selected for inclusion. Underutilization of advance care planning and palliative care resources was common. Where palliative care input was sought, this was frequently late in the course of the disease. No studies provided evidence-based clinical criteria for triggering referral to palliative care, a framework for providing tailored care in this patient group, or how to manage the risk of sudden cardiac death and implantable cardioverter defibrillators in advanced PAH-CHD. We synthesize this information into eight important areas, including the impact of PAH-CHD on quality of life, barriers to and benefits of palliative care involvement, advance care planning discussions, and end-of-life care issues in this complex patient group, and provide expert consensus on best practice in this field. CONCLUSIONS This paper presents the results of a systematic review and expert statements on the preferred palliative care strategy for patients with PAH-CHD.
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Affiliation(s)
- Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Robin Condliffe
- Pulmonary Vascular Disease UnitRoyal Hallamshire HospitalSheffieldUK
| | - Paul Clift
- Department of CardiologyQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Robert Tulloh
- Bristol Heart InstituteUniversity Hospitals Bristol, Weston NHS Foundation TrustBristolUK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
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6
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Schwerzmann M, Goossens E, Gallego P, Kovacs AH, Moons P, Swan L, Tobler D, de Stoutz N, Gabriel H, Greutmann M, Roos-Hesselink JW, Sobanski PZ, Thomet C. Recommendations for advance care planning in adults with congenital heart disease: a position paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD). Eur Heart J 2021; 41:4200-4210. [PMID: 32862229 DOI: 10.1093/eurheartj/ehaa614] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
Survival prospects in adults with congenital heart disease (CHD), although improved in recent decades, still remain below expectations for the general population. Patients and their loved ones benefit from preparation for both unexpected and predictable deaths, sometimes preceded by a prolonged period of declining health. Hence, advance care planning (ACP) is an integral part of comprehensive care for adults with CHD. This position paper summarizes evidence regarding benefits of and patients' preferences for ACP and provides practical advice regarding the implementation of ACP processes within clinical adult CHD practice. We suggest that ACP be delivered as a structured process across different stages, with content dependent upon the anticipated disease progression. We acknowledge potential barriers to initiate ACP discussions and emphasize the importance of a sensitive and situation-specific communication style. Conclusions presented in this article reflect agreed expert opinions and include both patient and provider perspectives.
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Affiliation(s)
- Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Pastora Gallego
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n. 41013 Seville, Spain
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN-62 Portland, Oregon, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium.,Institute of Health and Care Science, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa
| | - Lorna Swan
- Division of Cardiology, Peter Munk Cardiac Centre; Toronto Congenital Cardiac Centre for Adults, University of Toronto, 585 University Avenue; Toronto ON M5G 2N2, Canada
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 44031 Basel, Switzerland
| | - Noémi de Stoutz
- European Society of Cardiology Patient Forum Representative, Member of "Cuore Matto" and Global ARCH, Dorfstrasse 64, 8126 Zumikon, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, Erasmus University, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Piotr Z Sobanski
- Palliative Care Unit and Competence Center, Department of Internal Medicine, Hospital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Corina Thomet
- Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.,Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium
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7
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Krasuski MR, Serfas JD, Krasuski RA. Approaching End-of-Life Decisions in Adults with Congenital Heart Disease. Curr Cardiol Rep 2020; 22:173. [PMID: 33040248 DOI: 10.1007/s11886-020-01428-5] [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] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Despite tremendous advances in medical and surgical care, some adults with congenital heart disease (ACHD) develop terminal conditions where therapy is limited. This paper reviews the important role of palliative care, advance care planning (ACP), and end-of-life (EOL) care in ACHD. RECENT FINDINGS Recent studies suggest that ACP is infrequently utilized in ACHD. Patients generally express interest in learning more about EOL care, though few ACHD providers have received adequate training to confidently conduct these discussions. Most barriers to communication are largely addressable, and an organized approach to ACP that encourages active patient participation followed by clear documentation is more likely to be successful. Palliative care appears complementary to standard medical care and can be introduced at any stage of illness, with proven benefit in similar patient populations. ACP is an important part of the routine care for all ACHD. Patient preferences should be identified early and palliative methods incorporated whenever necessary.
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Affiliation(s)
- Matthew R Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - John D Serfas
- Division of Cardiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Richard A Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, NC, 27710, USA.
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8
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Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, Hsia TY, Hsu DT, Kovacs AH, McCrindle BW, Newburger JW, Pike NA, Rodefeld M, Rosenthal DN, Schumacher KR, Marino BS, Stout K, Veldtman G, Younoszai AK, d'Udekem Y. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e234-e284. [PMID: 31256636 DOI: 10.1161/cir.0000000000000696] [Citation(s) in RCA: 407] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has been 50 years since Francis Fontan pioneered the operation that today bears his name. Initially designed for patients with tricuspid atresia, this procedure is now offered for a vast array of congenital cardiac lesions when a circulation with 2 ventricles cannot be achieved. As a result of technical advances and improvements in patient selection and perioperative management, survival has steadily increased, and it is estimated that patients operated on today may hope for a 30-year survival of >80%. Up to 70 000 patients may be alive worldwide today with Fontan circulation, and this population is expected to double in the next 20 years. In the absence of a subpulmonary ventricle, Fontan circulation is characterized by chronically elevated systemic venous pressures and decreased cardiac output. The addition of this acquired abnormal circulation to innate abnormalities associated with single-ventricle congenital heart disease exposes these patients to a variety of complications. Circulatory failure, ventricular dysfunction, atrioventricular valve regurgitation, arrhythmia, protein-losing enteropathy, and plastic bronchitis are potential complications of the Fontan circulation. Abnormalities in body composition, bone structure, and growth have been detected. Liver fibrosis and renal dysfunction are common and may progress over time. Cognitive, neuropsychological, and behavioral deficits are highly prevalent. As a testimony to the success of the current strategy of care, the proportion of adults with Fontan circulation is increasing. Healthcare providers are ill-prepared to tackle these challenges, as well as specific needs such as contraception and pregnancy in female patients. The role of therapies such as cardiovascular drugs to prevent and treat complications, heart transplantation, and mechanical circulatory support remains undetermined. There is a clear need for consensus on how best to follow up patients with Fontan circulation and to treat their complications. This American Heart Association statement summarizes the current state of knowledge on the Fontan circulation and its consequences. A proposed surveillance testing toolkit provides recommendations for a range of acceptable approaches to follow-up care for the patient with Fontan circulation. Gaps in knowledge and areas for future focus of investigation are highlighted, with the objective of laying the groundwork for creating a normal quality and duration of life for these unique individuals.
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9
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Advanced care planning in adult congenital heart disease: Transitioning from repair to palliation and end-of-life care. Int J Cardiol 2019; 279:57-61. [DOI: 10.1016/j.ijcard.2018.10.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/07/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
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10
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Steiner JM, Kovacs AH. Adults with congenital heart disease – Facing morbidities and uncertain early mortality. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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11
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Edwards LA, Bui C, Cabrera AG, Jarrell JA. Improving outpatient advance care planning for adults with congenital or pediatric heart disease followed in a pediatric heart failure and transplant clinic. CONGENIT HEART DIS 2018; 13:362-368. [DOI: 10.1111/chd.12579] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Lindsay A. Edwards
- Texas Children's Hospital; Lillie Frank Abercrombie Section of Pediatric Cardiology; Houston Texas USA
- Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
| | - Christine Bui
- Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
- Department of Medicine; Baylor College of Medicine; Houston Texas USA
| | - Antonio G. Cabrera
- Texas Children's Hospital; Lillie Frank Abercrombie Section of Pediatric Cardiology; Houston Texas USA
- Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
| | - Jill Ann Jarrell
- Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
- Section of Academic General Pediatrics; Texas Children's Hospital; Houston Texas USA
- Texas Children's Hospital; Section of Palliative Care; Houston Texas USA
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12
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Deng LX, Gleason LP, Khan AM, Drajpuch D, Fuller S, Goldberg LA, Mascio CE, Partington SL, Tobin L, Kim YY, Kovacs AH. Advance Care Planning in Adults with Congenital Heart Disease: A Patient Priority. Int J Cardiol 2017; 231:105-109. [DOI: 10.1016/j.ijcard.2016.12.185] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/19/2016] [Accepted: 12/31/2016] [Indexed: 01/21/2023]
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14
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Abstract
Adolescents with congenital heart disease (CHD) are a rapidly growing population with complex medical needs and psychosocial challenges. Identity formation is an important developmental task accomplished during the teenage years. This article reviews different aspects of ongoing care that pertain to teenagers with CHD, with a particular focus on primary care issues and a summary of recommendations from various scientific societies. A successful smooth transition to the adult health care setting should achieve 2 important goals: to prevent loss of follow-up and to foster and encourage self-care behaviors.
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Affiliation(s)
- Pooja Gupta
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201-2119, USA.
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Psychosocial Functioning and Quality of Life in Adults with Congenital Heart Disease and Heart Failure. Heart Fail Clin 2014; 10:35-42. [DOI: 10.1016/j.hfc.2013.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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