Sarah Chuzi1, Sarah Hale2, Jason Arnold2, Amy Zhou2, Rebecca Harap2, Kathleen L Grady3, Jonathan D Rich2, Clyde W Yancy2, Adeboye Ogunseitan4, Eytan Szmuilowicz4, Jane E Wilcox2. 1. Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: sarah-chuzi@northwestern.edu. 2. Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 3. Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 4. Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Abstract
INTRODUCTION: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of "palliative care assessment" and preparedness planning. RESULTS: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning-device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities-were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. CONCLUSIONS: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
INTRODUCTION: In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS: All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of "palliative care assessment" and preparedness planning. RESULTS: Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning-device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities-were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. CONCLUSIONS: One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
Authors: Theresa Tenge; David Santer; Daniel Schlieper; Manuela Schallenburger; Jacqueline Schwartz; Stefan Meier; Payam Akhyari; Otmar Pfister; Silke Walter; Sandra Eckstein; Friedrich Eckstein; Martin Siegemund; Jan Gaertner; Martin Neukirchen Journal: Front Cardiovasc Med Date: 2022-06-29
Authors: Sarah Chuzi; Adeboye Ogunseitan; Kenzie A Cameron; Kathleen Grady; Lauren Schulze; Jane E Wilcox Journal: J Am Heart Assoc Date: 2021-07-26 Impact factor: 5.501