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Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
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Improving Communication in Heart Failure Patient Care
Nathan E Goldstein1, Harriet Mather2, Karen McKendrick2
1Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Journal of the American College of Cardiology
|September 28, 2019
Summary
Clinician education improved discussions about deactivating implantable cardioverter-defibrillators (ICDs) in heart failure patients nearing end of life. This intervention increased deactivation conversations, especially for those not eligible for advanced therapies.
Area of Science:
- Cardiology
- Medical Ethics
- Palliative Care
Background:
- Implantable cardioverter-defibrillators (ICDs) prevent sudden cardiac death but may deliver shocks to dying heart failure (HF) patients.
- Discussing ICD deactivation at end-of-life is crucial to prevent unwanted shocks and align care with patient goals.
Purpose of the Study:
- To evaluate if a clinician-centered teaching intervention and automatic reminders increase discussions and deactivation of ICDs.
- To assess the impact on goals of care conversations and advance directive completion.
Main Methods:
- A 6-center, single-blinded, cluster-randomized controlled trial involving 525 advanced HF patients with ICDs.
- Intervention group received clinician education and reminders; control group did not.
- Primary outcomes: ICD deactivation discussions and device deactivation. Secondary outcomes: goals of care conversations and advance directive completion.
Main Results:
- No overall difference in ICD deactivation discussions or deactivation between groups.
- However, the intervention significantly increased deactivation discussions in patients not candidates for advanced therapies (25% vs. 11%).
- Goals of care conversations increased in the intervention group (47% vs. 38%).
Conclusions:
- The intervention successfully increased conversations about ICD deactivation and goals of care among HF patients.
- Clinicians adapted communication strategies based on patient illness severity.
- Further research may be needed to optimize deactivation discussions for all HF patients.
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