Shunichi Nakagawa1, Hiroo Takayama2, Koji Takeda2, Veli K Topkara2, Lauren Yuill3, Suzanne Zampetti4, Katherine McLaughlin4, Melana Yuzefpolskaya5, Paolo C Colombo5, Yoshifumi Naka2, Nir Uriel5, Craig D Blinderman4. 1. Department of Medicine, Adult Palliative Care Service, Columbia University Irving Medical Center, New York, New York, USA. Electronic address: sn2573@cumc.columbia.edu. 2. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA. 3. Department of Care Coordination and Social Work, Adult Palliative Care Service, NewYork-Presbyterian Hospital, New York, New York, USA. 4. Department of Medicine, Adult Palliative Care Service, Columbia University Irving Medical Center, New York, New York, USA. 5. Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Abstract
CONTEXT: Palliative care consultation before left ventricular assist device (LVAD) surgery (PreVAD) has been recommended, but its impact on goal-concordant care is unknown. OBJECTIVES: To describe the association between patients' unique unacceptable condition articulated during PreVAD with the actual care provided at the end of life. METHODS: Among 308 patients who had PreVAD between 2014 and 2019, 72 patients died before December 31, 2019. Based on the answers to the question, "Is there any condition you would find unacceptable?" patients were divided into ARTICULATE (those who could articulate their unacceptable condition clearly, n = 58) and non-ARTICULATE (those who could not, n = 14). Circumstances at death and end-of-life care were compared between groups. RESULTS: Mean age at death was 63.2 years (SD ±13.1), 56 patients (77.8%) were males, and median duration of LVAD was 167.5 days (interquartile range 682). ARTICULATE patients died less frequently in the intensive care unit than non-ARTICULATE patients (33 patients, 57.9% vs. 13 patients, 92.9%; P = 0.014) and had ethics consultation less frequently (four patients, 6.9% vs. five patients, 35.7%; P = 0.011). Frequency of LVAD withdrawal was similar in both groups. Among ARTICULATE cohort, the unacceptable condition articulated in PreVAD did not seem to influence decisions at the end of life. CONCLUSION: Patients who articulated their unacceptable condition clearly before LVAD surgery had less frequent ethics consultations and received less intensive care at the end of life, but it did not seem to affect the decision of LVAD withdrawal. It may be more important to engage in discussions around their unacceptable conditions, rather than the specific condition articulated. The question of an unacceptable condition should be part of any routine palliative care consultation before LVAD surgery.
CONTEXT: Palliative care consultation before left ventricular assist device (LVAD) surgery (PreVAD) has been recommended, but its impact on goal-concordant care is unknown. OBJECTIVES: To describe the association between patients' unique unacceptable condition articulated during PreVAD with the actual care provided at the end of life. METHODS: Among 308 patients who had PreVAD between 2014 and 2019, 72 patientsdied before December 31, 2019. Based on the answers to the question, "Is there any condition you would find unacceptable?" patients were divided into ARTICULATE (those who could articulate their unacceptable condition clearly, n = 58) and non-ARTICULATE (those who could not, n = 14). Circumstances at death and end-of-life care were compared between groups. RESULTS: Mean age at death was 63.2 years (SD ±13.1), 56 patients (77.8%) were males, and median duration of LVAD was 167.5 days (interquartile range 682). ARTICULATE patientsdied less frequently in the intensive care unit than non-ARTICULATE patients (33 patients, 57.9% vs. 13 patients, 92.9%; P = 0.014) and had ethics consultation less frequently (four patients, 6.9% vs. five patients, 35.7%; P = 0.011). Frequency of LVAD withdrawal was similar in both groups. Among ARTICULATE cohort, the unacceptable condition articulated in PreVAD did not seem to influence decisions at the end of life. CONCLUSION:Patients who articulated their unacceptable condition clearly before LVAD surgery had less frequent ethics consultations and received less intensive care at the end of life, but it did not seem to affect the decision of LVAD withdrawal. It may be more important to engage in discussions around their unacceptable conditions, rather than the specific condition articulated. The question of an unacceptable condition should be part of any routine palliative care consultation before LVAD surgery.
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