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Ethical challenges with the left ventricular assist device as a destination therapy

Overview of attention for article published in Philosophy, Ethics, and Humanities in Medicine, January 2008
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (91st percentile)

Mentioned by

blogs
1 blog
twitter
2 tweeters
wikipedia
1 Wikipedia page
pinterest
1 Pinner

Citations

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96 Dimensions

Readers on

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141 Mendeley
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Title
Ethical challenges with the left ventricular assist device as a destination therapy
Published in
Philosophy, Ethics, and Humanities in Medicine, January 2008
DOI 10.1186/1747-5341-3-20
Pubmed ID
Authors

Aaron G Rizzieri, Joseph L Verheijde, Mohamed Y Rady, Joan L McGregor

Abstract

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers.Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 141 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Costa Rica 1 <1%
Australia 1 <1%
Canada 1 <1%
Unknown 137 97%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 29 21%
Student > Master 24 17%
Researcher 19 13%
Student > Doctoral Student 14 10%
Other 12 9%
Other 35 25%
Unknown 8 6%
Readers by discipline Count As %
Medicine and Dentistry 53 38%
Nursing and Health Professions 21 15%
Engineering 19 13%
Psychology 10 7%
Social Sciences 9 6%
Other 16 11%
Unknown 13 9%

Attention Score in Context

This research output has an Altmetric Attention Score of 13. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 July 2015.
All research outputs
#1,235,857
of 13,572,747 outputs
Outputs from Philosophy, Ethics, and Humanities in Medicine
#58
of 185 outputs
Outputs of similar age
#11,733
of 130,813 outputs
Outputs of similar age from Philosophy, Ethics, and Humanities in Medicine
#1
of 1 outputs
Altmetric has tracked 13,572,747 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 90th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 185 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.0. This one has gotten more attention than average, scoring higher than 68% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 130,813 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them