Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
Department of Medicine, Division of Hematology/Oncology, Palliative Medicine, Mayo Clinic, Phoenix, Arizona.
J Card Fail. 2017 Sep;23(9):708-712. doi: 10.1016/j.cardfail.2016.12.001. Epub 2016 Dec 5.
Beliefs around deactivation of a left ventricular assist device (LVAD) vary substantially among clinicians, institutions, and patients. Therefore, we sought to understand perspectives regarding LVAD deactivation among cardiology and hospice/palliative medicine (HPM) clinicians.
We administered a 41-item survey via electronic mail to members of 3 cardiology and 1 HPM professional societies. A convergent parallel mixed-methods design was used. From October through November 2011, 7168 individuals were sent the survey and 440 responded. Three domains emerged: (1) LVAD as a life-sustaining therapy; (2) complexities of the process of LVAD deactivation; and (3) legal and ethical considerations of LVAD deactivation. Most respondents (cardiology 92%; HPM 81%; P = .15) believed that an LVAD is a life-sustaining treatment for patients with advanced heart failure; however, 60% of cardiology vs 2% of HPM clinicians believed a patient should be imminently dying to deactivate an LVAD (P < .001). Additionally, 87% of cardiology vs 100% of HPM clinicians believed the cause of death following LVAD deactivation was from underlying disease (P < .001), with 13% of cardiology clinicians considering it to be a form of euthanasia or physician-assisted suicide.
Cardiology and HPM clinicians have differing perspectives regarding LVAD deactivation. Bridging the gaps and engaging in dialog between these 2 specialties is a critical first step in creating a more cohesive approach to care for LVAD patients.
在临床医生、医疗机构和患者中，对左心室辅助装置（LVAD）停用的看法存在很大差异。因此，我们试图了解心脏病学和临终关怀/姑息治疗（HPM）临床医生对 LVAD 停用的看法。
我们通过电子邮件向 3 个心脏病学和 1 个 HPM 专业协会的成员发送了一份 41 项的调查问卷。采用收敛平行混合方法设计。2011 年 10 月至 11 月期间，向 7168 人发送了调查，有 440 人做出了回应。出现了三个领域：（1）LVAD 作为维持生命的治疗；（2）LVAD 停用过程的复杂性；（3）LVAD 停用的法律和伦理考虑。大多数受访者（心脏病学 92%；HPM 81%；P=0.15）认为，对于晚期心力衰竭患者，LVAD 是一种维持生命的治疗方法；然而，60%的心脏病学医生与 2%的 HPM 医生认为，患者应处于即将死亡的状态才能停用 LVAD（P<0.001）。此外，87%的心脏病学医生与 100%的 HPM 医生认为，LVAD 停用后死亡的原因是基础疾病（P<0.001），其中 13%的心脏病学医生认为这是一种安乐死或医生协助自杀。
心脏病学和 HPM 临床医生对 LVAD 停用的看法存在差异。弥合这两个专业之间的差距并进行对话是为 LVAD 患者创造更具凝聚力的护理方法的关键第一步。
