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.