title: Complex Care Options for Patients With Advanced Heart Failure Approaching End of Life.
abstract: Care for patients with advanced cardiac disease continues to evolve in a complex milieu of therapeutic options, advanced technological interventions, and efforts at improving patient-centered care and shared decision-making. Despite improvements in quality of life and survival with these interventions, optimal supportive care across the advanced illness trajectory remains diverse and heterogeneous. Herein, we outline challenges in prognostication, communication, and caregiving in advanced heart failure and review the unique needs of patients who experience frequent hospitalizations, require chronic home inotropic support, and who have implantable cardioverter-defibrillators and mechanical circulatory support in situ, to name a few.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Palliative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA. wordingham.sara@mayo.edu.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Wordingham
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora and Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA. colleen.mcilvennan@ucdenver.edu.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: McIlvennan
authors.affiliation: School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA. dionneod@uab.edu.
authors.forename: J Nicholas
authors.initials: JN
authors.lastname: Dionne-Odom
authors.affiliation: Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center; Birmingham VA Medical Center; and Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA. kswetz@uab.edu.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
mesh_terms: D017028:Caregivers; D003142:Communication; D003657:Decision Making; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D017051:Hospice Care; D006801:Humans; D010166:Palliative Care; D018802:Patient-Centered Care; D011379:Prognosis; D013727:Terminal Care
keywords: Advance care planning; Caregiver; End of life; Heart failure; Inotropes; Mechanical circulatory support; Palliative care; Ventricular assist device
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