Haider Warraich
speaker
683 appearances
3 recordings
1 series
first heard Oct 2020
last heard Dec 2021
Haider Warraich’s voice in public audio — every appearance, attributed to the second.
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And so then you can turn it off without this garish, really violent siren going off, which can be completely disconcerting.
So I guess a few things, you know, just to summarize my sort of general thoughts about this topic.
I think every patient, no matter what their health status, should have a right to turn off an LVAD.
And if not, then we need to make it clear before we put in the device that that shouldn't be something that's dropped on someone after the fact.
The second thing is that if someone is considering deactivating an LVAD, the right place to do it is in the hospital where you have the intensive therapies available and the monitoring available to make it happen in a sort of peaceful, dignified way.
The third is if you're going to give meds to keep them comfortable, do it before and then know your device.
And then I would say that this needs experience.
This can be a difficult thing to do.
So the more the heart failure team and the palliative care team work together, the better these really, really difficult situations can be.
We have some nursing protocols, but it's mostly, but I actually, at my current institution, I do not know if you have protocols, but I'll go and check and I'll make sure we do have one.
And I'll add one thing.
This is a shout out to the University of Utah, which has a great palliative care program.
But they actually did like a quasi-natural experiment to answer that exact same question, not just have palliative care see patients with LVADs at that time of implant, but really follow them because they had patients who were
both at their VA and at their university.
And at one center, they were able to have, they had longitudinal follow-up, and at the other, they didn't.
And one of their nurses, one of their VAD coordinators, she said something that I always remember.
She said that the patients didn't have different outcomes, but when a patient had a bad outcome and they had been seeing palliative care, their caregivers, the patient's caregiver, their reaction to that outcome was very, very different.
And so I do think that it shouldn't just be a one-time thing checking the box.
It really should be a longitudinal relationship that develops with palliative care for these patients long-term.
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