Facilitating Timely Advance Care Planning: Discussions in the Ambulatory Setting With a Heart Failure Population

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 and guide ACP discussions with patients determined to have a prognosis of life expectancy of 3 years or less. The project yielded a 35% completion of ACP tools over 3 months, with 100% of these entered into the electronic health record. Postimplementation surveys suggest clinic staff believe a comprehensive and systematic approach to ACP services facilitates timely ACP discussions and decision making in the outpatient setting.
Source: Journal of Hospice and Palliative Nursing - Category: Nursing Tags: Feature Articles Source Type: research

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We report the case of a 47-year-old man who was diagnosed with severe right ventricular outflow tract (RVOT) stenosis due to a space-occupying lesion; the diagnosis was made using computed tomography. He underwent mass reduction, pulmonary valve replacement, and RVOT reconstruction with a bovine pericardial patch. The pathological diagnosis was undifferentiated pleomorphic sarcoma originating from the myocardium. As the mass resection was incomplete, he received heavy particle therapy. He did not want to receive adjuvant chemotherapy. Four months later, severe RVOT stenosis recurred because the residual mass had invaded th...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
The American population is getting older and sicker. More Americans are facing life-threatening illness when approaching end of life. Palliative care has grown to meet the complex needs of this population. And yet, according to a 2017 article in the journal Palliative Care, many people living with a chronic life-threatening illness either do not receive any palliative care, or receive services only in the last phase of their illness. The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care also addressed this issue, stating that a goal of their recently updated guidelines is “to improve...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Caregiving End of life Pain Management Source Type: blogs
ConclusionsAreas of interest include myocardiocyte regeneration, tissue graft development to minimize reoperations, and methods of stem cell delivery. While several small trials are showing promise, it is too soon to make definitive statements about the future of stem cell therapies in this field.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: REVIEW ARTICLE Source Type: research
Conditions:   Heart Failure NYHA Class III;   Heart Failure NYHA Class IV Intervention:   Behavioral: FamPALcare Sponsors:   West Virginia University;   National Institute of Nursing Research (NINR) Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
This article reviews current trends in the use of DT VAD, adverse events in children versus adults on VAD, and provides a framework for patient selection employing a multi-disciplinary approach including palliative care. The general approach to determining DT VAD candidacy should include: 1) a reasonable success that the patient will survive the peri- and post-operative state and 2) a high likelihood that the patient will be able to be discharged out of hospital and have adequate caregiver support. Patients with muscular dystrophy and failing Fontan physiology are examples of two pediatric populations for whom DT VAD may b...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Cardiogenic shock continues to have unacceptably high in-hospital mortality of over 50% and ST-segment elevation myocardial infarction (STEMI) is the leading cause of cardiogenic shock among other causes such as myocarditis, non-ST-elevation myocardial infarction, acute exacerbation of chronic heart failure, and pulmonary embolism.1 STEMI resulting in left ventricular failure accounts for 70 –80% of STEMI complicated with cardiogenic shock (STEMI-CS) and the prevalence of STEMI-CS was 6.5 to 10.1% in the United States between 2003–2010.
Source: Heart and Lung - Category: Intensive Care Authors: Source Type: research
No abstract available
Source: Journal of Hospice and Palliative Nursing - Category: Nursing Tags: DEPARTMENTS: CE Tests Source Type: research
Purpose of review Heart failure is a frequent problem in an ageing population, associated with high rates of morbidity and mortality. Today, it is important to not only treat heart failure itself but also the related comorbidities. Among them, cardiac cachexia is one of the major challenges. It is a complex multifactorial disease with a negative impact on quality of life and prognosis. Therefore, prevention, early recognition and treatment of cardiac cachexia is essential. Recent findings Cardiac cachexia frequently presents with skeletal as well as heart muscle depletion. Imaging-based diagnostic techniques can help ...
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research
Purpose of review The selection and application of outcome measures are fundamental steps in the research process because they inform decisions around intervention efficacy. We aimed to describe the outcomes used in trials of supportive interventions for adult caregivers of people with three exemplar life-limiting conditions: heart failure, dementia or stroke. Recent findings We performed a focussed review of 134 published trials that included interventions designed to improve caregivers’ health and wellbeing and/or ability to function in their caring role. We extracted and categorized all caregiver outcomes des...
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research
CORRIGENDUM: Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patients - A Single-Center Experience of 5-Year Follow-up. Circ J. 2019;83(11):2389 Authors: Hamatani Y, Nakai E, Nakamura E, Miyata M, Kawano Y, Takada Y, Anchi Y, Funabashi S, Hirayama A, Kuroda K, Amano M, Sugano Y, Anzai T, Izumi C PMID: 31656274 [PubMed - in process]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
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