Tenge Theresa, Santer David, Schlieper Daniel, Schallenburger Manuela, Schwartz Jacqueline, Meier Stefan, Akhyari Payam, Pfister Otmar, Walter Silke, Eckstein Sandra, Eckstein Friedrich, Siegemund Martin, Gaertner Jan, Neukirchen Martin
Department of Anesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany.
Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany.
Front Cardiovasc Med. 2022 Jun 29;9:879378. doi: 10.3389/fcvm.2022.879378. eCollection 2022.
Repeat hospitalizations, complications, and psychosocial burdens are common in patients with left ventricular assist devices (LVAD). Specialist palliative care (sPC) involvement supports patients during decision-making until end-of-life. In the United States, guidelines recommend early specialist palliative care (esPC) involvement prior to implantation. Yet, data about sPC and esPC involvement in Europe are scarce.
This is a retrospective descriptive study of deceased LVAD patients who had received sPC during their LVAD-related admissions to two university hospitals in Duesseldorf, Germany and Basel, Switzerland from 2010 to 2021. The main objectives were to assess: To which extent have LVAD patients received sPC, how early is sPC involved? What are the characteristics of those, how did sPC take place and what are key challenges in end-of-life care?
In total, 288 patients were implanted with a LVAD, including 31 who received sPC (11%). Twenty-two deceased LVAD patients (19 male) with sPC were included. Mean patient age at the time of implantation was 67 (range 49-79) years. Thirteen patients (59%) received LVAD as destination therapy, eight patients (36%) were implanted as bridge to transplantation (BTT), and one as an emergency LVAD after cardiogenic shock (5%). None of the eight BTT patients received a heart transplantation before dying. Most ( = 13) patients lived with their family and mean Eastern Cooperative Oncology Group (ECOG) performance status was three. Mean time between LVAD implantation and first sPC contact was 1.71 years, with a range of first sPC contact from 49 days prior to implantation to more than 6 years after. Two patients received esPC before implantation. In Duesseldorf, mean time between first sPC contact and in-hospital death was 10.2 (1-42) days. In Basel, patients died 16 (0.7-44) months after first sPC contact, only one died on the external sPC unit. Based on thorough examination of two case reports, we describe key challenges of sPC in LVAD patients including the necessity for sPC expertise, ethical and communicative issues as well as the available resources in this setting.
Despite unequivocal recommendations for sPC in LVAD patients, the integration of sPC for these patients is yet not well established.
左心室辅助装置（LVAD）患者反复住院、出现并发症以及承受心理社会负担的情况很常见。专科姑息治疗（sPC）的介入可在决策直至生命终末期为患者提供支持。在美国，指南建议在植入LVAD之前尽早让专科姑息治疗（esPC）介入。然而，关于欧洲sPC和esPC介入情况的数据却很匮乏。
这是一项对2010年至2021年期间在德国杜塞尔多夫和瑞士巴塞尔的两家大学医院因与LVAD相关的住院而接受sPC的已故LVAD患者的回顾性描述性研究。主要目的是评估：LVAD患者在多大程度上接受了sPC，sPC介入有多早？接受sPC患者的特征是什么，sPC是如何开展的，以及临终关怀中的关键挑战是什么？
共有288例患者植入了LVAD，其中31例接受了sPC（11%）。纳入了22例接受sPC的已故LVAD患者（19例男性）。植入时患者的平均年龄为67岁（范围49 - 79岁）。13例患者（59%）接受LVAD作为目标治疗，8例患者（36%）作为过渡到心脏移植（BTT）植入，1例在心源休克后作为紧急LVAD植入（5%）。8例BTT患者中无一例在死前接受心脏移植。大多数（n = 13）患者与家人一起生活，东部肿瘤协作组（ECOG）的平均体能状态为3级。LVAD植入与首次sPC接触之间的平均时间为1.71年，首次sPC接触的时间范围从植入前49天到植入后6年多。2例患者在植入前接受了esPC。在杜塞尔多夫，首次sPC接触与院内死亡之间的平均时间为10.2天（1 - 42天）。在巴塞尔，患者在首次sPC接触后16个月（0.7 - 44个月）死亡，只有1例在外部sPC病房死亡。基于对两份病例报告的详细检查，我们描述了LVAD患者sPC的关键挑战，包括对sPC专业知识的需求、伦理和沟通问题以及该环境下可用的资源。
尽管对于LVAD患者的sPC有明确的建议，但sPC在这些患者中的整合尚未得到很好的确立。
