Complex Care Options for Patients With Advanced Heart Failure Approaching End of Life
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Care for patients with advanced cardiac disease continues to evolve in a complex milieu of therapeutic options, advanced technological interventions, and efforts at improving patient-centered care and shared decision-making. Despite improvements in quality of life and survival with these interventions, optimal supportive care across the advanced illness trajectory remains diverse and heterogeneous. Herein, we outline challenges in prognostication, communication, and caregiving in advanced heart failure and review the unique needs of patients who experience frequent hospitalizations, require chronic home inotropic support, and who have implantable cardioverter-defibrillators and mechanical circulatory support in situ, to name a few.
KeywordsVentricular assist device Heart failure Mechanical circulatory support Advance care planning Caregiver Inotropes Palliative care End of life
End of life
Quality of life
Left ventricular assist device
Mechanical circulatory support
Centers for Medicare & Medicaid Services
Compliance with Ethical Standards
Conflict of Interest
Sara E. Wordingham and Colleen K. McIlvennan declare that they have no conflict of interest.
J. Nicholas Dionne-Odom is a postdoctoral fellow supported by a National Palliative Care Research Center Career Development Award.
Keith M. Swetz has received salary support from the US Federal Government (Department of Veterans Affairs; Birmingham Veterans Affairs Medical Center).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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