Deactivation of Left Ventricular Assist Devices: Differing Perspectives of Cardiology and Hospice/Palliative Medicine Clinicians
Deactivation of Left Ventricular Assist Devices: Differing Perspectives of Cardiology and Hospice/Palliative Medicine Clinicians
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DOI：
10.1016/j.cardfail.2016.12.001
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发表时间：
2017-09-01
影响因子：
6
通讯作者：
Swetz, Keith M.
中科院分区：
文献类型：
--
作者：
Mcilvennan, Colleen K.;Wordingham, Sara E.;Swetz, Keith M.
背景：临床医生、机构和患者对左心室辅助装置（LVAD）失活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/姑息医学（HPM）临床医生对左室辅助功能失活的看法。方法与结果：我们通过电子邮件对3个心脏病学和1个HPM专业学会的成员进行了41项调查。采用收敛并行混合方法设计。从2011年10月到11月，7168人接受了调查，440人做出了回应。出现了三个领域：(1)LVAD作为一种维持生命的疗法；(2) LVAD失活过程的复杂性；(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LVAD是晚期心力衰竭患者的一种维持生命的治疗方法；然而，60%的心脏病学医生和2%的HPM临床医生认为，患者应该在即将死亡时停用左室辅助装置（P < 0.001）。此外，87%的心脏病学医生和100%的HPM医生认为LVAD失活后的死亡原因是潜在的疾病（P < 0.001）， 13%的心脏病学医生认为这是安乐死或医生协助自杀的一种形式。结论：心脏病学和HPM临床医生对LVAD失活有不同的看法。弥合这两个专业之间的差距并参与对话是创建更有凝聚力的LVAD患者护理方法的关键的第一步。
Background: 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.Methods and Results: 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.Conclusion: 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.