🫁 End-Stage Heart Failure — Palliative vs Aggressive Therapy Simulator

End-Stage Heart Failure Assessment

Baseline staging sets the frame for every downstream decision.

• IV: NYHA Class (symptoms at rest)
• ~50%: 1-yr mortality (stage D estimate)
• 3+: Hospitalizations (in past 12 months)
• <25%: Ejection fraction (severely reduced)

Clinical staging basics

Short placeholder: staging combines symptoms, hemodynamics, and trajectory.

Aggressive Therapy Escalation Pathways

LVAD, transplant, and inotropes aim to extend survival.

• ~80%: LVAD 1-yr survival (destination therapy)
• 6-12 mo: Transplant wait (typical median)
• high: Inotrope risk (arrhythmia burden)
• frailty: Candidacy filter (main exclusion driver)

Escalation tradeoffs

Short placeholder: each option trades procedural risk for extended survival.

Palliative Symptom Management Approach

Comfort-directed care targets dyspnea, pain, and fatigue.

• high: Symptom relief (opioids, diuretics)
• <6 mo: Hospice eligible (prognosis estimate)
• ~40%: Readmission drop (with home hospice)
• lower: Caregiver burden (vs aggressive care)

Comfort care basics

Short placeholder: symptom control replaces disease-modifying escalation.

Eliciting Patient Goals and Priorities

Structured conversation aligns therapy with patient values.

• 30-60m: Discussion length (recommended session)
• update: Advance directive (reviewed each visit)
• yes: Family involved (shared conversation)
• yes: Decision aid used (structured tool)

Conversation framework

Short placeholder: values clarification precedes any pathway commitment.

Shared Decision and Care Pathway Outcome

Final pathway blends prognosis, function, and stated priority.

• higher: Concordant choice (satisfaction reported)
• option: Time-limited trial (reassess later)
• yes: Reversible choice (can be revisited)
• required: Documented plan (chart update)

Finalizing the plan

Short placeholder: the chosen pathway is documented and reassessed over time.

Short placeholder: decisions are revisited as status changes.