Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014

2021 ◽  
pp. 104990912110218
Author(s):  
Karol Quelal ◽  
Olankami Olagoke ◽  
Anoj Shahi ◽  
Andrea Torres ◽  
Olisa Ezegwu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nationwide Inpatient Sample ◽  
Metastatic Cancer ◽  
The United States ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Incidence Trends ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation. Aim: This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014. Methods: We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis. Results: We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC. Conclusion: There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.

Palliative Care Nursing in the Outpatient Setting

2019 ◽  
pp. 639-651
Author(s):  
Pamela Stitzlein Davies ◽  
Kathleen Broglio
Keyword(s):  
Palliative Care ◽  
Ambulatory Care ◽  
Care Program ◽  
The United States ◽  
Outpatient Setting ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ambulatory Care Setting ◽  
Ventricular Assist

Most healthcare in the United States is provided in ambulatory care clinics. Yet, outside of the arena of oncology, palliative care clinics are rare in the outpatient setting. This is an area of great need, and one that is expected to see significant growth, given the complexities of issues managed by primary clinicians. Palliative care can assist with decisions related to initiating or discontinuing left ventricular assist devices for destination therapy or renal replacement therapy and address the multimorbidity, frailty, and dementia associated with the growing population of elder adults. This chapter addresses the benefits and challenges faced when providing palliative care in the ambulatory care setting. Practical aspects of initiating or expanding an outpatient palliative care program are discussed, as well as unique aspects of providing palliative care to various clinical specialties in the outpatient setting. Additionally, best practices for monitoring opioid and other controlled substances are reviewed, including methods to implement Universal Precautions for screening and monitoring patients receiving these prescriptions.

Intersection of Heart Failure and Pregnancy: Beyond Peripartum Cardiomyopathy

2021 ◽  
Author(s):  
Ersilia M. DeFilippis ◽  
Jennifer H. Haythe ◽  
Mary Norine Walsh ◽  
Michelle M. Kittleson
Keyword(s):  
Heart Failure ◽  
Pregnant Women ◽  
De Novo ◽  
Systolic Dysfunction ◽  
The United States ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Common Diagnosis

Heart failure (HF) is a leading cause of morbidity and mortality in pregnant women in the United States. Although peripartum cardiomyopathy is the most common diagnosis for pregnant women with HF, women with preexisting cardiomyopathies and systolic dysfunction are also at risk as the hemodynamic demands of pregnancy can lead to decompensation, arrhythmia, and rarely death. The differential diagnosis of HF in pregnancy is broad and includes Takotsubo or stress cardiomyopathy, exacerbation of a preexisting cardiomyopathy, such as familial cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or left ventricular noncompaction. This review will explore the implications of pregnancy in women with preexisting cardiomyopathies and de novo HF, risk assessment and preconception planning, decisions about contraception, the safety of HF medications and implantable cardioverter-defibrillators during pregnancy, pregnancy in women with left ventricular assist devices and following heart transplantation.

scholarly journals PREVALENCE AND PREDICTORS OF STATIN USE IN LONG-STAY NURSING HOME RESIDENTS WITH LIFE-LIMITING ILLNESSES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S861-S861
Author(s):  
Deborah S Mack ◽  
Kate L Lapane
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Home Setting ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Statin Use

Abstract Statins are one of the most commonly prescribed medications in the United States. While statin use has been studied extensively in the general population, national data on statin use in US nursing homes do not exist. This study estimated the point prevalence of statin use on September 1, 2016 and identified predictors of statin use in nursing home residents with life limiting illness. We conducted a cross-sectional analysis using national MDS 3.0 data linked to Medicare claims. We identified 424,312 long-stay residents with life limiting illnesses defined as a palliative care consultation (ICD-10 Z51.5), prognosis &lt;6 months on MDS, the Veterans Health Administration palliative care index (PCI), or a diagnosis of a serious illness (e.g., cancer, stroke, heart failure, etc.). Poisson models accounted for clustering of residents within facilities. Overall, 34% were on statins which varied by age (65-75 years: 44.1%; &gt;75 years: 31.5%). The strongest positive predictor of statin use was hyperlipidemia, while coronary artery disease and stroke were only marginally predictive across age. The strongest negative predictors were a palliative care consultation or a prognosis &lt;6 months, while PCI was not strongly associated with use. A substantial proportion of long stay nursing home residents with life limiting illnesses continue statin therapy despite evidence of net harm. Efforts to deprescribe statins in the nursing home setting may be warranted. These findings can be used to help identify and target missed opportunities to reduce the therapeutic burden and improve end-of-life care for the US nursing home population.

scholarly journals Characteristics and Outcomes of COVID-19 in Patients on Left Ventricular Assist Device Support

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Edo Y. Birati ◽  
Samer S. Najjar ◽  
Ryan J. Tedford ◽  
Brian A. Houston ◽  
Supriya Shore ◽  
...  
Keyword(s):  
Heart Failure ◽  
The United States ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Presenting Symptoms ◽  
Left Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. Methods: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry. Results: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46–68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations. Conclusions: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.

Palliative Care in Mechanical Circulatory Support

2019 ◽  
pp. 23-28
Author(s):  
Regina M. Mackey ◽  
Jacob J. Strand
Keyword(s):  
Palliative Care ◽  
Perioperative Period ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Difficult Decision ◽  
Palliative Care Teams ◽  
Advance Care

Palliative care teams are increasingly involved in the care of patients with advanced circulatory failure and play an important role in the care of patients undergoing implantation of left ventricular assist devices. Palliative care teams focus on symptom management, caregiver support, and robust advance care planning for patients in the pre-implantation and post-implantation phase of care. Preoperative envolvement of Palliative care is effective in helping the patient articulate his/her goals and reason for pursuing surgical intervention as well as declaring just how committed the patient is to long term medical care should various types of complications occur in the perioperative period. This provides comfort to the family when a difficult decision has to be made at a time when the patient can’t take an active part in making that decision. Effective Palliative care teams are present to celebrate the victories as well as the failures in patient care.

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