Abstract
Introduction: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. Methods: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of “palliative care assessment” and preparedness planning. Results: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning—device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities—were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. Conclusions: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
Original language | English (US) |
---|---|
Pages (from-to) | 100-107 |
Number of pages | 8 |
Journal | Journal of Pain and Symptom Management |
Volume | 57 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2019 |
Funding
Research reported in this publication was supported, in part, by the Northwestern University Bluhm Cardiovascular Institute (BCVI) Clinical Trials Unit. The authors would like to thank the patients and their caregivers in our VAD program. The authors also acknowledge Duc Thinh Pham, MD, Surgical Director, Center for Heart Failure, and Allen S. Anderson, MD, Medical Director, Center for Heart Failure, BCVI Northwestern University.
Keywords
- Palliative care
- destination therapy
- heart failure
- left ventricular assist device
ASJC Scopus subject areas
- General Nursing
- Clinical Neurology
- Anesthesiology and Pain Medicine