Opinion EDITORIAL Albert Liu, MD; Gregory Curfman, MD There is growing evidence that patients have varying priori- decision making is that clinicians are transparent with their ties at the end of their life. Some want to focus on maximiz- recommendations—and their implications, both positive and ing their quality of life, whereas others focus on living negative. When survival benefit is overemphasized and risks are underestimated, patients risk deciding on therapies that longer. Current clinical 8,9 practice prioritizes the latter. are inconsistent with their goals. Related article For example, most cardiac Left ventricular assist devices may provide symptom re- device trials use overall sur- lief for patients and improve survival, but they continue to be vival as the primary outcome, instead of quality-adjusted life associated with considerable symptoms including pain, 2-4 years (QALYs). What is left unsaid is that these mortality ben- major depression, and organic mental syndromes. Device- efits often come at a cost: discomfort, loss of mobility, poly- related adverse events include stroke, infection, bleeding, pharmacy with its attendant adverse effects, procedural com- pump thrombosis, ventricular arrhythmias, and right ven- plications, device failure, or loss of functional status. tricular heart failure. Owing to the substantial risk of major
JAMA Internal Medicine – American Medical Association
Published: Apr 26, 2018
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