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 percent) 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 those receiving a TAVR. Only 34 percent 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 clinicians should receive more training in palliative care,” says James N. Kirkpatrick, MD, FACC, 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.

Keywords: Advance Care Planning, Cardiovascular Diseases, Centers for Medicare and Medicaid Services, U.S., Heart-Assist Devices, Hospice Care, Hospices, Medicaid, Medicare, Palliative Care, Referral and Consultation, Specialization, Transcatheter Aortic Valve Replacement

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