Withdrawal of Cardiac Medications and Devices

2007 ◽  
Vol 18 (4) ◽  
pp. 415-425
Author(s):  
Debra Lynn-McHale Wiegand ◽  
Peggy G. Kalowes
Keyword(s):  
Treatment Options ◽  
Healthcare Providers ◽  
Ventricular Assist Devices ◽  
Healthcare Team ◽  
Ventricular Assist ◽  
Her Family ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Ethical And Legal Considerations ◽  
Cardioverter Defibrillators

Withdrawal of life-sustaining therapies such as cardiac medications, pacemakers, internal cardioverter defibrillators, and ventricular assist devices occurs in patients with advanced cardiac disease as goals of treatment transition from active to less aggressive. This article defines life-sustaining therapies and describes ethical and legal considerations related to withdrawal of cardiac medications and cardiac devices. Healthcare providers need to anticipate clinical situations in which implantable cardiac devices and medications are no longer desired by patients and/or are no longer medically appropriate. Discussions are important between patients, families, and healthcare providers that focus on each patient’s condition, prognosis, advance directives, goals of care, and treatment options. Critical care nurses support each patient and his or her family and work with other members of the healthcare team to achieve a peaceful death.

Mechanisms of Platelet Dysfunction in Patients with Implantable Devices

2017 ◽  
Vol 44 (01) ◽  
pp. 012-019 ◽  
Author(s):  
Joshua Casan ◽  
Robert Andrews ◽  
Elizabeth Gardiner ◽  
Amanda Davis
Keyword(s):  
Treatment Options ◽  
Modern Medicine ◽  
Ventricular Assist Devices ◽  
Coagulation Cascade ◽  
Ventricular Assist ◽  
Platelet Surface ◽  
Transcatheter Aortic Valve ◽  
Clinical Complications ◽  
Cardiac Devices ◽  
Hemostatic System

AbstractAs treatment options in modern medicine continue to expand, physicians globally have witnessed a veritable explosion in the utility of therapeutic devices. Particularly within the spheres of cardiology and critical care medicine, a plethora of devices are now available with an ever-increasing range of clinical indications. Additionally, the advent of transcatheter-mounted devices has enabled patients unsuitable for more invasive procedures to benefit from intervention, thereby greatly expanding the cohort of device-eligible patients. However, despite advances in design and materials, as well as pharmacological prophylaxis, hemostatic complications continue to plague device recipients, contributing to morbidity and mortality. Elucidating the complex interplay between components of the hemostatic system and cardiac devices has been the subject of much recent research, with greater focus on the coagulation cascade and device-induced perturbations. However, less is known about impact of mechanical surfaces on platelets and the resultant clinical complications, both hemorrhagic and thrombotic. This review will focus on exploring the pathobiology of platelet–surface interactions, contextualized within the wider hemostatic system, with a focus on the increasingly utilized technologies of transcatheter aortic-valve implantation, ventricular assist devices, and extracorporeal membrane oxygenation.

scholarly journals GAINING INTERPROFESSIONAL COMPETENCE THROUGH A GERIATRICS CASE CONFERENCE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S151
Author(s):  
Amber S McIlwain ◽  
Danielle Backus ◽  
Kristine Marcus ◽  
Jeff Fortner
Keyword(s):  
Interprofessional Education ◽  
Healthcare Providers ◽  
Core Competency ◽  
Healthcare Team ◽  
Case Conference ◽  
Her Family ◽  
Centered Care ◽  
Geriatric Disorder ◽  
Positive Response Rate ◽  
Care Conference

Abstract There is increased demand to provide health professions students with interprofessional education and practice experience. Interprofessional Case Conferences (ICC) allow students to work in teams to learn about different professions while exploring a topic through the lens of an interprofessional core competency. The goal of this particular ICC was to provide students an experience to witness and discuss team-based, person-centered care for a common geriatric disorder. The case was designed to develop the interprofessional competency of teams and teamwork. Students were divided into teams and observed live vignettes of a care conference involving an 80-year old female admitted to a rehabilitation facility following a hip fracture and replacement. Students witnessed how patients, families, and healthcare providers work together during a stressful time. After each vignette, students discussed questions related to miscommunications, motivations of the different actors involved, and how the healthcare team should respond. In the first offering, 93 students participated, increasing to 150 in the next year. Students completed a post-survey to determine if the session delivered a positive interprofessional experience. The average positive response rate was 92.5% (92-94%, n = 53) in year-1 and 93.5% (90-97%, n = 71) in year-2. By allowing students to witness a simulated live care conference, they had a tangible event to dissect instead of discussing hypotheticals. By discussing a geriatrics case in a rehabilitation setting, students witnessed how numerous healthcare professions coordinate care for a patient and her family, thereby demonstrating competence in teamwork.

Economics of new therapies in electrophysiology

ESC CardioMed ◽  
2018 ◽  
pp. 3133-3135
Author(s):  
Giuseppe Boriani ◽  
Lucia D’Angiolella ◽  
Fabiana Madotto
Keyword(s):  
Cost Effective ◽  
Typical Case ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Resynchronization Therapy ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Effective Assessment ◽  
Cardioverter Defibrillators

Diagnostic and prognostic improvements in electrophysiology have been spectacular and mainly been attributable to the development of implantable cardiac devices, such as implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy pacemakers (CRT-Ps), and resynchronization therapy pacemakers with defibrillation therapy (CRT-D). These therapies are expensive because of both up-front initial implant costs and for subsequent check-up, device replacement, and possible complications. As this is a typical case in which a therapy is both costly and effective, assessment of cost-effectiveness of these device therapies becomes of paramount importance. According to recent studies, these treatments are broadly cost-effective when applied adequately and correctly analysed over a long-term period. The up-front initial cost of the devices and their implant are sometimes short-term barriers to the implementation of cost-effective therapeutic strategies.

Virtual clinics for follow-up of pacemakers and implantable cardioverter defibrillators in children

2019 ◽  
Vol 29 (10) ◽  
pp. 1243-1247
Author(s):  
Georgia Spentzou ◽  
Kaitlin Mayne ◽  
Helen Fulton ◽  
Karen McLeod
Keyword(s):  
Parent Satisfaction ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Devices ◽  
Digital Medicine ◽  
Implantable Cardiac Devices ◽  
System Data ◽  
Set Up ◽  
Cardioverter Defibrillators ◽  
Virtual Clinic

AbstractThere is growing interest in the use of digital medicine to reduce the need for traditional outpatient follow-up. Remote interrogation of pacemakers and implantable cardioverter defibrillators is now possible with most devices. The aim of our study was to evaluate the safety and efficacy of virtual pacing clinics in following up children with pacemakers and implantable cardioverter defibrillators, including epicardial systems.Methods:The study was retrospective over 8 years (2010–2017), with review of patient records and analysis of downloads from the implantable cardiac devices to the virtual clinics.Results:A total of 75 patients were set up for virtual clinic follow-up during the study period, 94.5% with a pacemaker and 5.5% an implantable cardioverter defibrillator. The majority (76.8%) had an epicardial system. Data on lead impedance, battery longevity, programmed parameters, detected arrhythmias, percentage pacing and delivered defibrillator therapies were obtainable by download. Lead threshold measurements were obtainable via download in 83.7% of the devices, including epicardial systems. No concerning device issue was missed. In 15% of patients a major issue was detected remotely, including three patients with lead fractures. The virtual clinics resulted in fewer hospital attendances while enhancing monitoring and enabling more frequent device checks. The vast majority (91.4%) of families who responded to a questionnaire were satisfied with the virtual clinic follow-up.Conclusions:Virtual clinics allow safe and effective follow-up of children with pacemakers and implantable cardioverter defibrillators, including those with epicardial systems and are associated with high levels of parent satisfaction.

Withdrawal of Cardiology Technology

2017 ◽  
Author(s):  
Patricia Maani Fogelman ◽  
Janine A. Gerringer
Keyword(s):  
Symptom Management ◽  
Electronic Devices ◽  
Healthcare Providers ◽  
Ventricular Assist Devices ◽  
Lifestyle Modifications ◽  
Ventricular Assist ◽  
Cardiovascular Implantable Electronic Devices ◽  
Treatment Plans ◽  
Physical Examinations ◽  
Advanced Treatments

The care of the cardiac patient requires exquisite assessment including history, physical examinations, and diagnostic data in order to make differential diagnoses and formulate individualized treatment plans. Interventions include education about lifestyle modifications, the introduction and titration of cardiac medications, and referral for more advanced treatments such as vasoactive or inotropic medications, cardiovascular implantable electronic devices, and ventricular assist devices. Often, patients decide to discontinue these therapies. Standardized protocols for withdrawal of life-sustaining respiratory therapies provide structured guidance, reduce variation in practice, and improve satisfaction of families and healthcare providers. This chapter reviews such therapies and the process for cessation while simultaneously attending to symptom management.

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