Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA.
Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA; MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
Ann Palliat Med. 2024 May;13(3):598-606. doi: 10.21037/apm-23-551. Epub 2024 Feb 27.
Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure (HF). Compared to guideline-directed medical and device therapies, LVAD technology improves quality of life and reduces mortality. Palliative care specialists have an important role to play in the pre-LVAD evaluation phase, in the post-operative longitudinal care phase, and at the end-of-life in patients with LVADs. The objective of this narrative review is to describe the evidence regarding the role of palliative care for patients with LVAD across the care continuum: pre-implantation, post-implantation, and at the end-of-life.
Clinical trials relevant to care of patients with HF, LVADs, and the role of palliative care were analyzed for this narrative review.
Palliative care involvement in 'preparedness planning' has been described in the literature, though no standardized protocol for preparedness planning exists, to date. In the longitudinal care phase after LVAD implantation, the role of palliative care is less defined; depending on institutional culture and availability of palliative care, patients may be referred based on symptom-management needs or for advance care planning (ACP). At the end-of-life, either due to an acute event or a gradually worsening condition, palliative care is often engaged to participate in discussions regarding treatment preferences and to consider transitions in care from disease-directed treatments to comfort-focused treatments. Given the medical complexity of dying with LVADs, most patients with an LVAD die in hospital with support from palliative care teams for the physical, existential, and psychosocial distress that accompanies end-of-life and LVAD deactivation.
In this narrative review, we describe the integral role of palliative care throughout the care continuum of patients living with LVADs and suggest opportunities for further research.
左心室辅助装置（LVAD）彻底改变了晚期心力衰竭（HF）患者的治疗方式。与指南指导的药物和器械治疗相比，LVAD 技术可提高生活质量并降低死亡率。姑息治疗专家在 LVAD 预评估阶段、术后长期护理阶段以及 LVAD 患者生命末期都扮演着重要的角色。本综述旨在描述姑息治疗在 LVAD 患者全病程护理中的作用，包括植入前、植入后和生命末期。
分析了与 HF 患者、LVAD 以及姑息治疗相关的临床试验，以进行本综述。
姑息治疗在“准备计划”中的参与已在文献中描述，尽管目前尚未制定准备计划的标准化方案。在 LVAD 植入后的长期护理阶段，姑息治疗的作用定义尚不明确；取决于机构文化和姑息治疗的可用性，可能会根据症状管理需求或预先医疗计划（ACP）进行转介。在生命末期，由于急性事件或病情逐渐恶化，姑息治疗通常会参与讨论治疗偏好，并考虑从疾病导向治疗向以舒适为中心的治疗的护理过渡。鉴于 LVAD 患者临终的医疗复杂性，大多数带 LVAD 患者在姑息治疗团队的支持下在医院死亡，姑息治疗团队可以缓解与生命末期和 LVAD 停用相关的身体、存在和心理社会困扰。
在本综述中，我们描述了姑息治疗在 LVAD 患者全病程护理中的重要作用，并提出了进一步研究的机会。
