The Trade-offs When Focusing on the Mortality Benefit

The Trade-offs When Focusing on the Mortality Benefit 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 rec- ties at the end of their life. Some want to focus on maximiz- ommendations—and their implications, both positive and nega- ing their quality of life, whereas others focus on living longer. tive. When survival benefit is overemphasized and risks are underestimated, patients risk deciding on therapies that are Current clinical practice prioritizes the latter. For example, most 8,9 cardiac device trials use over- inconsistent with their goals. all survival as the primary Left ventricular assist devices may provide symptom re- outcome, instead of quality- lief for patients and improve survival, but they continue to be Related article page 520 2-4 adjusted life years (QALYs). associated with considerable symptoms including pain, What is left unsaid is that these mortality benefits often come major depression, and organic mental syndromes. Device- at a cost: discomfort, loss of mobility, polypharmacy with its related adverse events include stroke, infection, bleeding, attendant adverse effects, procedural complications, device pump thrombosis, ventricular arrhythmias, and right failure, or loss of functional status. ventricular heart failure. Owing to the substantial risk of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

The Trade-offs When Focusing on the Mortality Benefit

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Publisher
American Medical Association
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
ISSN
2168-6106
eISSN
2168-6114
D.O.I.
10.1001/jamainternmed.2018.0067
Publisher site
See Article on Publisher Site

Abstract

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 rec- ties at the end of their life. Some want to focus on maximiz- ommendations—and their implications, both positive and nega- ing their quality of life, whereas others focus on living longer. tive. When survival benefit is overemphasized and risks are underestimated, patients risk deciding on therapies that are Current clinical practice prioritizes the latter. For example, most 8,9 cardiac device trials use over- inconsistent with their goals. all survival as the primary Left ventricular assist devices may provide symptom re- outcome, instead of quality- lief for patients and improve survival, but they continue to be Related article page 520 2-4 adjusted life years (QALYs). associated with considerable symptoms including pain, What is left unsaid is that these mortality benefits often come major depression, and organic mental syndromes. Device- at a cost: discomfort, loss of mobility, polypharmacy with its related adverse events include stroke, infection, bleeding, attendant adverse effects, procedural complications, device pump thrombosis, ventricular arrhythmias, and right failure, or loss of functional status. ventricular heart failure. Owing to the substantial risk of

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Apr 26, 2018

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