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Research Letter |

Palliative Care for Patients With End-Stage Cardiovascular Disease and Devices A Report From the Palliative Care Working Group of the Geriatrics Section of the American College of Cardiology

James N. Kirkpatrick, MD1; Paul J. Hauptman, MD2; Keith M. Swetz, MD3,4; Elizabeth D. Blume, MD5; Kimberlee Gauvreau, ScD5; Mathew Maurer, MD6; Sarah J. Goodlin, MD7
[+] Author Affiliations
1Division of Cardiology, Ethics Consultation Service, University of Washington, Seattle
2Division of Cardiology, Department of Medicine, Saint Louis University, St Louis, Missouri
3University of Alabama Birmingham Center for Palliative and Supportive Care, Birmingham
4Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
5Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
6Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
7Portland Veterans Affairs Medical Center and Patient-Centered Education and Research, Portland, Oregon
JAMA Intern Med. 2016;176(7):1017-1019. doi:10.1001/jamainternmed.2016.2096.
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This survey study assesses attitudes among clinicians toward palliative care in patients receiving transcatheter aortic valve replacement and ventricular assist devices.

Palliative care has not traditionally been seen as applicable to patients who are candidates for device-based therapies, including transcatheter aortic valve replacement (TAVR) and ventricular assist devices (VADs). However, although improvements in technology, expertise at implanting devices, and patient selection have been made,1 these devices come with a risk of morbid complications that can be particularly deleterious in elderly patients with preexisting comorbidities and impaired baseline functional and/or cognitive status.2 Therefore, we designed a survey of clinicians (physicians, nurses, and advanced practice practitioners) to assess attitudes toward and current status of palliative care in the approach to patients undergoing TAVR and VAD implantation procedures.

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Institutional Practices Regarding Palliative Care Consultation Among Respondents Who Care for Patients With Transcatheter Aortic Valve Replacement (TAVR) and Patients With Ventricular Assist Devices (VADs)

A, Percentages of respondents who care for patients with a TAVR or VAD regarding institutional protocols that involve formal palliative care consultation before implantation of the device. B, Responses regarding palliative care consultation for patients under consideration for TAVR and VAD who were not deemed to be candidates for the devices.

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