Patient and family/carer discussion using good communication techniques will be required when considering the options below in advanced care. The communication styles model within the key themes of HEARTe may help to clarify this and also the importance of considering self management within this scenario.
Remember a persons emotional reaction to their condition will clearly affect their motivation to pursue a self-management approach i.e. the social impact might be more crucial to address than the physical.
NB** Only when the QRS is prolonged and meets specific criteria, according to evidence based guidance and specialist review, is CRT a possible treatment option.
- Device
Cardiac re-syncronisation therapy (CRT -D) is used to help the pumping action of the heart become more effective. Ideally it’s best to optimise medications first. Frank is on optimal medical therapy but is still symptomatic therefore should be considered for a device. - LVAD
A left ventricular assist device (LVAD) is used as a bridge to heart transplant, this may be considered is patient is still symptomatic despite drug and device therapy. This is not an option at present for Frank, but may be something to consider in the future. - Palliative Care
Supportive and palliative care approaches can be combined with cardiac treatments. Frank is still being considered for other options but should be supported throughout the whole process. - Medications
Frank is already on a host of medication. Can we rationalise his medication so that he’s on evidence based medications to improve his conditions. Is this going to be enough for Frank?
Pulse point
Patient views and holistic assessment are required when considering options for advanced care, this will be discussed further in the palliative care module.
For more information please read:
For local resources patient and carer information please read:
- Chest Heart Stroke Scotland
- British Heart Foundation ICD DVD & booklet excellent
Page last reviewed: 28 Jul 2020
