Destination to nowhere: a new look at aggressive treatment for heart failure--a case study

Quality of life in patients with advanced heart failure and an implanted left ventricular assist device: an umbrella review protocol

OBJECTIVE

This review aims to evaluate the effectiveness of implanted left ventricular assist devices on quality of life in patients with advanced heart failure.

INTRODUCTION

Approximately 500,000 patients worldwide are diagnosed with advanced heart failure. The preferred treatment for patients who remain symptomatic after standard medical treatment is heart transplantation. However, due to the shortage of donor organs, left ventricular assist devices are increasingly used as an alternative. This umbrella review is necessary to advise clinicians so they may provide patients and families with clear information on standard medical treatment, implanted left ventricular assist devices and heart transplantation.

INCLUSION CRITERIA

This umbrella review will consider research syntheses that include patients 16 years or over with advanced heart failure and an implanted left ventricular assist device. The primary outcome is quality of life, and secondary outcomes include patient survival rates and the New York Heart Association functional classification changes.

METHODS

An initial search of PubMed and CINAHL has been undertaken to identify articles and create a search strategy. Retrieved articles will be screened against the inclusion criteria. Included studies will be critically appraised for methodological quality according to JBI umbrella review methodology, and data will be extracted using the standardized JBI data extraction tool. The results will be presented in a Summary of Evidence, and a GRADE Summary of Findings will be produced for grading the quality of the evidence.

Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program

Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.