Comparison of Trends, Mortality, and Readmissions After Insertion of Left Ventricular Assist Devices in Patients
End-stage heart failure that is refractory to medical therapy constitutes 5% of total heart failure population but has profound effects on quality of life with dismal survival.1 Palliative options with or without ionotropic therapies remained the only route for majority of these patients, with only few eligible for orthotropic heart transplant. The advent of durable left ventricular assist devices (LVADs) changed this paradigm after showing drastically improved outcomes, and are now widely accepted therapeutic options for eligible patients.
AbstractIntravenous inotropic therapy can be used in patients with advanced heart failure, as palliative therapy or as a bridge to cardiac transplantation or mechanical circulatory support, as well as in cardiogenic shock. Their use is limited to increasing cardiac output in low cardiac output states and reducing ventricular filling pressures to alleviate patient symptoms and improve functional class. Many advanced heart failure patients have sinus tachycardia as a compensatory mechanism to maintain cardiac output. However, excessive sinus tachycardia caused by intravenous inotropes can increase myocardial oxygen consumpti...
As techniques for corrective and palliative surgery in congenital heart disease improve, the number of patients surviving to become adults with congenital heart disease (ACHD) has increased. A significant proportion of these patients will progress to develop advanced heart failure, the symptoms of which vary, complicating prediction of life expectancy. Unlike acquired heart failure, there is a lack of evidence-based treatments with which to relieve symptoms and prolong survival. As a result, a number of ACHD patients will proceed to heart transplantation.
End-stage heart failure that is refractory to medical therapy constitutes 5% of total heart failure population but has profound effects on quality of life with dismal survival1. Palliative options with or without ionotropic therapies remained the only route for majority of these patients, with only few eligible for orthotropic heart transplant. The advent of durable left ventricular assist devices (LVADs) changed this paradigm after showing drastically improved outcomes, and are now widely accepted therapeutic options for eligible patients2-4.
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.
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.
Publication date: February 2020Source: Canadian Journal of Cardiology, Volume 36, Issue 2Author(s): Ashlay A. Huitema, Karen Harkness, Shiraz Malik, Neville Suskin, Robert S. McKelvieAbstractGlobally, there are ∼ 26 million people living with heart failure (HF), 50% of them with reduced ejection fraction, costing countries billions of dollars each year. Improvements in treatment of cardiovascular diseases, including advanced HF, have allowed an unprecedented number of patients to survive into old age. Despite these advances, patients with HF deteriorate and often require advanced therapies. As the proportion of elderly...
This article reviews current trends in the use of DT VAD and adverse events in children vs adults on VAD, and provides a framework for patient selection with the use of a multidisciplinary 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 postoperative 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 pediatric populations for whom DT VAD may b...
Therapeutic yoga (TY) gently supports the body in therapeutic positions and may include relaxation breathing, comforting touch, and mindfulness meditation (MM). Evidence suggests that yoga, relaxation, and MM can help reduce anxiety, pain, nausea, and constipation. We piloted a feasibility project at a large New York teaching hospital to expand an established palliative care TY/MM program to include supportive cardiology patients. These are patients with advanced heart failure who are often awaiting (or have received) cardiac transplant, ventricular assistive devices, or total artificial heart support.