Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Tel Aviv University, Israel.
Curr Opin Support Palliat Care. 2013 Mar;7(1):29-35. doi: 10.1097/SPC.0b013e32835d2d50.
The purpose of this review is to provide an overview of self- care and communication issues at the end of life of patients with left-ventricular assist devices (LVADs) for destination therapy, based on recent research on end-of-life communication in other diseases.
For many patients with advanced heart failure, LVADs as destination therapy improve survival and quality of life. However, LVADs can be associated with complications, new comorbidities or worsening of previous conditions, resulting in decreased quality of life and limited prognosis, raising the need for planning palliative and end-of-life care. Open communication addressing the consequences of the LVAD implantation for daily life and the future (including advance directives) is advised in different stages of the treatment, involving a multidisciplinary team taking care of these complex patients and their caregivers.
Healthcare professionals treating patients before and after LVAD implantation need to take an active role in end-of-life discussions and be able to communicate information regarding expected complications, quality of life and prognosis to the patients and caregivers. Research is needed addressing optimal ways and timing of communication with LVAD patients and families.
本综述旨在基于其他疾病末期沟通的最新研究，概述终末期左心室辅助装置 (LVAD) 治疗患者的自我护理和沟通问题。
对于许多晚期心力衰竭患者，LVAD 作为终末期治疗可提高生存率和生活质量。然而，LVAD 可能会引起并发症、新的合并症或先前病情恶化，导致生活质量下降和预后有限，从而需要计划姑息治疗和临终关怀。建议在治疗的不同阶段，由负责这些复杂患者及其护理人员的多学科团队进行开诚布公的沟通，讨论 LVAD 植入对日常生活和未来的影响（包括预立医嘱）。
在 LVAD 植入前后治疗患者的医疗保健专业人员需要在临终讨论中发挥积极作用，并能够将预期并发症、生活质量和预后等信息传达给患者及其护理人员。需要研究与 LVAD 患者及其家属进行沟通的最佳方式和时间。
