Editorial: Culture, treatment paradigms, and advanced heart failure

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Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

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Publication date: Available online 11 October 2019Source: Revista Española de Cardiología (English Edition)Author(s): Samuel D. Slavin, Haider J. WarraichAbstractHeart failure (HF) is a progressive condition with high mortality and heavy symptom burden. Despite guideline recommendations, cardiologists refer to palliative care at rates much lower than other specialties and very late in the course of the disease, often in the final 3 days of life. One reason for delayed referral is that prognostication is challenging in patients with HF, making it unclear when and how the limited resources of specialist palliat...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
This article provides a concise overview of the medical management of LVAD patients aimed for non-expert clinicians. Our presentation includes the basics of LVAD physiology, design and operation, patient selection, patient assessment, medical management, adverse event identification and management, multidisciplinary care, and management of special circumstances such as non-cardiac surgery, cardiac arrest, and end-of-life care. The clinical examination of LVAD patients is unique in terms of blood-pressure and heart-rate assessment, LVAD ‘hum’ auscultation, driveline/insertion-site inspection, and device-paramete...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractA large intra-cardiac tumor from the right ventricle to pulmonary trunk was detected by contrast-enhanced computed tomography and transthoracic echocardiography in a 59-year-old woman with progressive dyspnea on effort and acute congestive right-sided heart failure. Emergent surgical management was performed with cardiopulmonary bypass under cardiac arrest, however, tumor resection was incomplete, because it originated from the interventricular septum. Concomitant tricuspid valve replacement using a bioprosthesis was required due to the involvement of the septal leaflet of the tricuspid valve. Although large pulmon...
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Purpose of review Advanced heart failure in children is characterized by dynamic clinical trajectories, uncertainty of prognosis, and intermittent need for difficult decision-making, often related to novel therapeutic interventions with uncertain impact on quality of life. This review will examine the current role of palliative care to support this unique population. Recent findings Pediatric heart failure patients commonly die in ICUs with high burden of invasive therapies together with end of life care needs. In addition, several studies advocate for integration of palliative care early in disease trajectory, not on...
Source: Current Opinion in Pediatrics - Category: Pediatrics Tags: CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein Source Type: research
This quality improvement project utilized a risk stratification process and an advance care planning (ACP) tool to identify patients at high risk of death and prompt ACP discussions and documentation of health care preferences in the electronic health record. Inherent uncertainty in heart failure (HF) prognostication and provider time constraints impede initiation of timely ACP discussions. In an effort to mitigate these obstacles, the Seattle Heart Failure Model was utilized to calculate mortality risk for 195 patients in an ambulatory HF clinic. Next, a HF-specific ACP tool, developed for this project, was used to prompt...
Source: Journal of Hospice and Palliative Nursing - Category: Nursing Tags: Feature Articles Source Type: research
ConclusionsDaily critical care nurse telemonitoring resulted in nearly daily interventions with gradual stabilization of weight and vital signs, no decline in respiratory status, and no hospitalizations throughout 69 days of service. Of particular significance is the fact that telemonitoring improved the patient's compliance to his treatment plan, which resulted in an evaluation for a left ventricular assist device placement.
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
ConclusionsWe could not answer our primary objectives due to inadequate power. However, we provide novel placebo ‐controlled medium‐term benefit and safety data useful for clinical practice and future trial design. Morphine should only be prescribed in this population when other measures are unhelpful and with early management of side effects.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Abstract Management of chronic diseases is often palliative by definition. Empowering primary care providers to manage symptoms and effectively prognosticate is necessary for this challenging population. In this article, the authors focus specifically on end-stage congestive heart failure, chronic obstructive pulmonary disease, end-stage kidney disease, and end-stage liver disease and how palliative principles can guide decision making and symptom management in these disease states. Special considerations in advance care planning, initiation and cessation of advanced therapies, and discussions on when to initiate ...
Source: Primary Care - Category: Primary Care Authors: Tags: Prim Care Source Type: research
Abstract In the geriatric age group, few studies demonstrate the efficacy of aggressive treatment. Often, a more palliative approach is wanted; such an approach can lead to better quality of life and even a longer life. The author discusses the limits of medical interventions in the elderly, the paucity of data, and the benefits of palliation in certain medical conditions, including dementia, Parkinson, depression, arthritis, congestive heart failure, and pneumonia. The role of frailty is addressed; specific goals of palliative care are delineated, such as reduction of polypharmacy, fall prevention, pain reduction...
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Prim Care Source Type: research
The PAL-HF trial demonstrated that palliative care improves quality of life (QOL) in advanced heart failure (HF) patients as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ). Less is known about how palliative care affects specific domains which comprise the KCCQ overall summary score. Moreover, while a 5-pt change is commonly used to characterize clinical significance, this magnitude of change may have different implications based on where patients begin and end. We hypothesized that palliative care would impact individual KCCQ domains differently (i.e.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 427 Source Type: research
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