Managing Patients with Mechanical Circulatory Support Acrossthe Care Spectrum (SA521)

Abstract

1.Review the role of palliative care for patients with mechanical circulatory support in the inpatient setting.2.Explore care challenges for patients with mechanical circulatory support in the outpatient setting (home, nursing home, hospice).3.Discuss end-of-life management of mechanical circulatory support across the care continuum. Mechanical circulatory support (MCS) is being utilized with increasing prevalence for patients with advanced heart failure. The use of MCS (eg, ventricular assist devices and total artificial hearts) presents opportunities for hospice and palliative medicine (PM) providers to optimize care. The goal of this session is to demonstrate how PM providers can support patients receiving MCS across the care spectrum—from preimplantation to patients living with MCS and those endoflife. In the preimplantation period (often in the inpatient setting), PM consultation is recommended. Determination of patients' goals and preferences is important before they make the decision for MCS. Additionally, PM providers can help with preparedness planning—an advance care plan specific to MCS recipients. Although many PM providers are familiar with this concept, details regarding how to approach this or how to utilize models are not well known. We will discuss approaches to MCS candidates and recipients in the inpatient setting, with emphasis on how to complete a preparedness plan and how to document this in the chart. Patients with MCS also face unique challenges as outpatients. After their initial discharge, most patients will live months to years with their device as outpatients, although frequent inpatient stays are not uncommon. We will discuss the role of PM in supporting these patients as outpatients, at home, and during transitions. Lastly, nursing homes and hospices are often uncomfortable with managing patients with MCS, or lack providers certified to provide care for these patients. This can lead to significant disparities in care for these patients, particularly when approaching the end of life. Inpatient and home hospices are often asked to care for patients with MCS, but may not have protocols in place to provide optimal care. We will discuss end-of-life management with emphasis on hospice and nursing home-based protocols for deactivation and comfort care.