Nakagawa Shunichi, Yuzefpolskaya Melana, Colombo Paolo C, Naka Yoshifumi, Blinderman Craig D
1 Adult Palliative Care Service, Department of Medicine, Columbia University Medical Center , New York, New York.
2 Division of Cardiology, Department of Medicine, Columbia University Medical Center , New York, New York.
J Palliat Med. 2017 Sep;20(9):977-983. doi: 10.1089/jpm.2016.0568. Epub 2017 May 15.
The optimal level of palliative care (PC) involvement in left ventricular assist device (LVAD) therapy has yet to be determined.
Describe the feasibility of PC intervention to elucidate patients' goals and values in LVAD therapy in both destination therapy (DT) and bridge to transplant (BTT).
Single center, prospective, single-arm study.
SETTING/SUBJECTS: All patients who received mandatory PC consultation, using a semistructured script, before LVAD implantation (PreVAD evaluation).
We evaluated the feasibility of PreVAD evaluation and family awareness by analyzing responses and compared it between DT and BTT. We examined the association between withdrawal of LVAD therapy and family awareness in death cases.
Between January 2014 and September 2016, 112 patients (DT, 75; BTT, 37) underwent PreVAD evaluation. All patients could express what makes their life meaningful, and 101 (92.0%) could discuss possible complications. Seventy-nine patients (70.5%) could articulate their unacceptable health state. There was no difference between both groups. Family awareness increased significantly from 33.0% to 58.0% after PreVAD evaluation (p < 0.01). Five LVADs were deactivated among the 12 death cases, and they were all from the family-aware group (71.2% vs. 0%, p = 0.027).
Integrated PC intervention was feasible for both BTT and DT patients. Such an intervention may increase family awareness of the patient's unique concerns and may have an impact on decision making at the end of life.
姑息治疗（PC）在左心室辅助装置（LVAD）治疗中的最佳参与程度尚未确定。
描述PC干预在阐明终末期治疗（DT）和过渡到移植（BTT）中LVAD治疗患者的目标和价值观方面的可行性。
单中心、前瞻性、单臂研究。
设置/受试者：所有在LVAD植入前（PreVAD评估）接受强制性PC咨询的患者，采用半结构化脚本。
我们通过分析回复评估PreVAD评估和家属认知的可行性，并在DT和BTT之间进行比较。我们研究了死亡病例中LVAD治疗撤机与家属认知之间的关联。
2014年1月至2016年9月期间，112例患者（DT组75例，BTT组37例）接受了PreVAD评估。所有患者都能表达使他们生活有意义的事情，101例（92.0%）能讨论可能的并发症。79例患者（70.5%）能阐明他们不可接受的健康状态。两组之间无差异。PreVAD评估后家属认知从33.0%显著增加到58.0%（p < 0.01）。12例死亡病例中有5例LVAD停用，且均来自家属认知组（71.2%对0%，p = 0.027）。
综合PC干预对BTT和DT患者均可行。这种干预可能会提高家属对患者独特关注点的认知，并可能对临终决策产生影响。
