Palliative care is uncommon following TAVR or VAD implantation

Most clinicians who responded to a survey said their hospitals and institutions did not include palliative care as part of their protocol for treating patients who are implanted with cardiovascular device-based therapies, including transcatheter aortic valve replacement (TAVR) and ventricular assist devices (VADs).

Lead researcher James N. Kirkpatrick, MD, of the University of Washington in Seattle, and colleagues published their results in JAMA Internal Medicine on May 23.

“In our study, respondents reported that palliative care is mostly initiated following an adverse event, and most institutions lack protocols to integrate it in TAVR or VAD processes,” they wrote. “In general, palliative care was reported to be used more frequently in patients undergoing VAD than TAVR procedures.”

The researchers sent a 44-item survey to members of the American College of Cardiology from Nov. 1, 2014, to Jan. 31, 2015. Participants were asked to complete the survey if they cared for patients with a TAVR and/or VAD. However, the researchers said they could not verify if the respondents met that criteria.

Of the 323 respondents, 52.3 percent were physicians, and 85.8 percent of the physicians practiced adult cardiology.

In addition, 88.3 percent of respondents said palliative care could be helpful with TAVR and 83.4 percent said palliative care could be helpful with VAD. Meanwhile, 42.5 percent said their institutions required advance directives before implanting a TAVR device and 51.3 percent said they required advance directives before implanting a VAD.

However, 56.1 percent of respondents who care for patients with VADs and 34.4 percent who care for patients with a TAVR said palliative care consultation was often or always provided for patients deemed ineligible for these devices.

Although 82.6 percent of respondents said they had knowledge of palliative care, only 13.6 percent said their knowledge was extensive and only 10.5 percent said they received formal instructions on palliative care during their cardiovascular training.

The results may not be generalizable to other populations, according to the researchers, because they only had a moderate number of responses to the survey and the respondents gave a relatively high rating of palliative care services.

“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 who care for patients (especially the elderly with comorbidities) undergoing implantation of TAVRs or VADs and, by extension, undergoing other high-risk cardiovascular procedures,” the researchers wrote.