Center for Circulatory Support. The Center for Circulatory Support strives for continuous improvement in quality and patient outcomes

Transcription

1 Palliative Care Cnsults: Centers fr Medicare and Medicaid Services Decisin Mem fr Ventricular Assist Devices fr Bridge-t-Transplant and Destinatin Therapy Center fr Circulatry Supprt The Center fr Circulatry Supprt strives fr cntinuus imprvement in quality and patient utcmes

2 We have n financial r ther cnflicts f interest related t this presentatin. Any mentin f ff-label use f drugs will be clearly mentined as such.

3 Statistics 5.1 millin peple in the US have heart failure - CDC ,000 in the terminal phase - Rughly 2% They suffer frm severe symptms that are nt respnsive t maximized medical therapy Heart transplantatin prvides the greatest survival benefit fr these patients but has limited availability

4 Left Ventricular Assist Devices Used at University f Michigan HeartMate II Thratec Crpratin HeartWare HartWare Crpratin

5 Statistics 309 VAD patients in Michigan * (9/22/2014) 635 ttal UMHS implants (since 1996) 540 implants, 95 re-implants Tp implanting center in the state f Michigan and ne f the tp in the US 140 patients currently n VAD supprt *Intermacs = Interagency Registry fr Mechanically Assisted Circulatry Supprt

6 Scial Supprt 24 hur supervisin by trained caregiver Transprtatin Minimum 3 mnths pst-surgery Ptential fr 24 hur supervisin indefinitely N driving Practical supprt Daily driveline dressing changes Assistance with medicatin rganizatin, equipment, etc. Emtinal supprt Adjustment t lifestyle and rle changes Cping Anxiety Depressin Other Psychscial Indicatrs Financial Health insurance, prescriptin cverage, cverage f ther expenses (transprtatin, caregiver cmpensatin, husing, etc.) Mental Health Vilence Treatment histry, willingness t engage in treatment, current/histry f SI, impact f mental health n cmpliance Dmestic vilence, legal issues Substance Abuse Treatment histry, cnsequences f use, impact n cmpliance Cgnitive Functin Neurcgnitive testing nly by referral Cping Style Cncerning patterns/impact n medical care? Health Literacy/Cmpliance Medicatins, diet, fllw-up care, medical recmmendatins, scial wrk recmmendatins

7 Pst Implant Cmplicatins Bleeding Arrhythmia Infectin Respiratry Failure Renal Failure Right Heart Failure Cerebrvascular Event Device Malfunctin

8 OCTOBER 31, 2014 Centers fr Medicaid and Medicare will implement a new Natinal Cverage Decisin, requiring certified VAD Centers t have a Palliative Care expert invlved in the pre-perative phase f VAD care.

9 Multidisciplinary Care At least ne physician with cardithracic surgery privileges and individual experience implanting at least 10 durable, extracrpreal, left ventricular VADs as BTT r DT ver the curse f the previus 36 mnths with activity in the last year At least ne cardilgist trained in advanced heart failure with clinical cmpetence in medical and device-based management including VADs, and clinical cmpetence in the management f patients befre and after heart transplant A VAD prgram crdinatr A scial wrker A palliative care specialist Facilities must be credentialed by an rganizatin apprved by CMS

10 Preparedness Planning Figure curtesy f: Swetz, et al, June 2011

11 Cases fr Discussin

12 References J Pain Symptm Manage May; 47(5): e6. di: /j.jpainsymman Epub 2013 Oct 2. Preparedness planning befre mechanical circulatry supprt: a "hw-t" guide fr palliative medicine clinicians. Swetz, KM, et al May Clin Prc Jun; 86(6): di: /mcp Palliative medicine cnsultatin fr preparedness planning in patients receiving left ventricular assist devices as destinatin therapy. Swetz KM1, Jurnal f the American Heart Assciatin. 2011September;124:e305-e311. Di: /CIRCULATIONAHA Ventricular Assist devices: Imprtant infrmatin fr Patients and Families. Givertz, Michael M. CMS.gv Centers fr Medicare and Medicaid CDC Center Fr Disease Cntrl