CLINICAL
NEWS JOURNAL WRAP
Kim Eagle, MD, and the editors of ACC.org, present relevant
articles taken from various journals.
ICD Patients Face
Long-term Risk
of Device-related
Complications
Patients receiving implantable cardioverter defibrillators (ICDs) have a
high rate of device-related complication and reoperation for other causes
in the years following implantation,
according to a recent study published
in Annals of Internal Medicine.
Using data fr om the ACC’s ICD
Registry™, the study included
114,484 patients aged 65 and older
who had received an ICD for the first
time between 2006 and 2010. Data
from the ICD Registry™ was linked to
Medicare fee-for-service claims data.
Most of the patients in the study were
implanted with a dual-chamber device
Patients Receiving VAD or TAVR
Devices Not Often Provided with
Palliative Care Consultations
Most institutions lack protocols to
integrate palliative care in the processes when implanting transcatheter
aortic valve replacement (TAVR) and
ventricular assist devices (VADs), according to a research letter published
May 23 in JAMA Internal Medicine.
The research letter looked at
results of an ACC member survey
about caring for patients with a TAVR
and/or VAD. Of 323 respondents, the
majority (52.3%) were physicians
practicing adult cardiology.
Although palliative care was
viewed favorably by most respondents, the study indicated “a low rate
of formal inclusion of palliative care
consultation in institutional protocols.” Use of palliative care was higher
in patients receiving a VAD than
20 CardioSource WorldNews: Interventions
those receiving a TAVR. Only 34%
of respondents reported that they
received formal palliative care education in their cardiovascular training
programs. “These findings and the
substantial workforce shortage in
palliative care indicate a need for
more research into barriers that limit
provision of palliative care and for
training opportunities for clinicians,”
the authors assert.
“Given the importance of palliative care in patients undergoing
TAVR and VAD, and in light of the
Centers for Medicare and Medicaid
Services and The Joint Commission requirement that palliative
care specialists must be involved in
care teams for destination therapy
VAD patients, cardiovascular clini-
cians should receive more training
in palliative care,” says James N.
Kirkpatrick, MD, lead author and a
member of ACC’s Geriatric Cardiology Section. “It is important to
remember that palliative care can
be instituted alongside of life-prolonging interventions. Palliative care
is not synonymous with hospice.
Symptom management and advance
care planning are important for
patients with serious cardiovascular
diseases at any stage of the treatment process,” he adds.
Moving forward, Kirkpatrick suggests that future studies address the
long-term impact and patient-centered
outcomes of palliative care for patients with TAVR and VAD. He adds
that novel ways to address the palliative care clinician shortage should
be investigated, including training
cardiovascular clinicians in “basic” or
“primary” palliative care.
Kirkpatrick JN, Hauptman PJ, Swetz KM, et
al. JAMA Intern Med. 2016;176(7):1017-9.
Patients receiving
implantable
cardioverter
defibrillators (ICDs)
have a high rate
of device-related
complication and
reoperation.
July/August 2016