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This important study followed a cohort of patients with NYHA Class III or IV heart failure and assessed their life-sustaining treatment preferences, advance care planning, and quality of end-of-life care communication with their specialist physician. While patients' burden of treatment and outcome of treatment affected their end-of-life care preferences, their physicians rarely discussed prognosis, dying, and palliative care. This study demonstrates the need for specialist physician involvement in advance care planning
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Raphael CE, Koa-Wing M, Stain N, et al. Implantable cardioverter- defibrillator recipient attitudes towards device deactivation: how much do patients want to know? Pacing Clin Electrophysiol 2011;34:1628-1633. This important study showed that most patients who had an ICD placed for primary prevention did not know that an ICD could be deactivated. As many patients felt that a discussion on ICD deactivation should occur prior to implantation, care providers should include advance care planning as part of the discussion prior to ICD implantation.
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Petrucci RJ, Benish LA, Carrow BL, et al. Ethical considerations for ventricular assist device support: a 10-point model. ASAIO J 2011;57:268-273. This important study provides a model to address the ethical and psychosocial issues that should be discussed with patients undergoing VAD support. They include the risks and benefits of device placement, an advance directive, and plans for device replacement or withdrawal.
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Rogers JG, Bostic RR, Tong KB, et al. Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy. Circ Heart Fail 2012;5:10-16. This study calculates the incremental cost-effectiveness of continuous flow LVADs at approximately US$200 000. Although still not costeffective under currently accepted guidelines, this represents a significant improvement over the original pulsatile flow device.
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