RENOVATE Palliative Study: Randomized Clinical Trial
Conditions: Care, Palliative; Respiratory Failure Interventions: Device: High Flow Nasal Cannula; Other: Standard respiratory support Sponsors: Hospital do Coracao; Ministry of Health, Brazil; Fisher and Paykel Healthcare Not yet recruiting
Patients with heart failure (HF) requiring advanced therapies (AT) or palliative inotropes have been well described in the literature, but less is known regarding their earlier clinical course. Patients started on inotropes may be appropriate candidates for AT, yet do not always receive timely evaluations. Given the high mortality associated with end stage HF, we investigated the clinical characteristics and outcomes of HF patients after initiation of inotrope therapy.
Long-term, continuous intravenous inotropic support (CIIS) is frequently initiated for palliation of symptoms related to advanced heart failure (AHF) in patients who are not eligible for heart transplantation or mechanical circulatory support (MCS). Although the use of CIIS has increased in prevalence over the past decade, robust data regarding quality of life (QOL) outcomes in these patients are lacking. We wished to describe healthcare utilization and QOL outcomes in patients on palliative CIIS.
Risk factors such as diabetes mellitus (DM) have been associated with increased risk of mortality in patients with heart failure (HF). Obesity in diabetic patients worsens outcomes. However, there appears to be an obesity paradox in which stable HF patients with higher body mass index (BMI) have better survival. We sought to evaluate the association of DM and BMI with mortality in patients with end stage HF on palliative inotropic therapy.
Cardiac allograft vasculopathy (CAV) is one of the leading causes of late mortality among heart transplant recipients. Retransplantation, although considered the only definitive therapy, is not a feasible option for most patients. Percutaneous coronary intervention (PCI) with drug eluting stents (DES) or bare metal stents (BMS) has become a palliative, more accessible therapy. We conducted a systematic review and meta-analysis to investigate clinical outcomes of DES vs BMS.
To evaluate the clinical characteristics of patients withdrawn from veno-arterial extracorporeal membrane oxygenation support (VA-ECMO), as well as the role of palliative care (PC) consultation in the decision to withdraw VA-ECMO.
The American Heart Association and American Stroke Association have put forth statement recommending early and continuous access to palliative care for patients with heart disease. There is a national shortage of palliative care providers, and often outpatient palliative care clinics are not profitable to institutions with billing alone. However, early integration of palliative care has been proven to improve the quality of life of patients with advanced heart failure. Other studies have suggested that general palliative care has cost savings to hospital systems.
Palliative care (PC) has been shown to improve outcomes for seriously ill patients but has not been fully integrated into the care of lung transplant patients. Little is known about the palliative care needs for this population. Our goal was to describe adult lung transplant candidates ’ perspectives of their PC needs.
Authors: PMID: 32221134 [PubMed - in process]
(Canadian Medical Association Journal) Palliative care physicians have created a coronavirus disease 2019 (COVID-19) palliative care plan as an essential tool to provide care and help manage scare resources during the pandemic. The plan, which focuses on eight critical elements -- 'stuff,' 'staff,' 'space,' 'systems,' 'sedation,' 'separation,' 'communication' and 'equity' -- is published in CMAJ (Canadian Medical Association Journal).
Conclusions When managing patients with decades-long disease and multiple comorbidities, clinicians must be realistic about the low odds of effecting cure and adjust treatment expectations accordingly. For patients with SE-AN, a variety of low-intensity treatment approaches, at times extending to palliative and hospice care, may be useful. Clinicians should always strive to provide humane comfort and support, as closely aligned to patients' judicious wishes as realistically possible.