Structural heart disease: One valve does not fit all.
Creator
German KS; Kalra A
Publisher
Current opinion in supportive and palliative care
Date
2019
2019-03
Description
PURPOSE OF REVIEW: Highlight the difficulties patients, physicians, and the global economy face in relation to treatment of structural heart diseases. It is easy to be carried away by the excitement of medical advancement; however, it is difficult to demonstrate restraint. Transcatheter aortic valve replacement (TAVR) is a modern marvel that can help many patients when utilized appropriately. This article highlights the work that has been done to facilitate decision-making in this challenging patient population. RECENT FINDINGS: Patient selection is of paramount importance as TAVR remains a costly intervention. Currently, our gold standards for preprocedural patient evaluation are inadequate. Apropos, several objective tools are being developed to help clinicians evaluate frailty. Giving patients a more accurate postprocedure prognosis allows them to make informed decisions on whether this intervention is appropriate for their respective goals. SUMMARY: In order for us to fully embrace shared decision-making and cost-effectiveness, we must continue to work on our prognostic tools and have honest conversations with patients and their families to formulate individualized treatment plans. This becomes even more important when factors like economic impact of intervention are considered. In an era where cost-effective care has garnered more attention than ever before, we must do our best to make sure our interventions are in line with patient goals and offer the maximum amount of benefit, given the current cost of TAVR.
Subject
Humans; Prognosis; Age Factors; Risk Factors; Severity of Illness Index; Risk Assessment; Cost-Benefit Analysis; Patient Care Planning; Patient Participation; Decision Making Shared; Frailty/epidemiology; Heart Valve Diseases/surgery; Transcatheter Aortic Valve Replacement/economics/methods/mortality
BACKGROUND: Diagnostic errors appear to be the most common, costly, and dangerous of all medical mistakes. There has been a notable increase on the focus of error prevention as part of a growing patient safety movement. However, diagnostic errors have received less attention than other types of error. Our goal is to present a short mnemonic that can act as a checklist or posted reminder to help practitioners in dermatology or any field of medicine to avoid diagnostic errors. METHODS: To meet this goal, the authors reviewed the literature and discussed errors and potential errors they have experienced over 55 years of combined practice, to create a short mnemonic. RESULTS: The CARE method has helped the authors prepare and review their differential diagnoses in the relatively fast-paced practice of dermatology, but it has yet to be tested on a large scale. CONCLUSION: The CARE (communicate, assess for biased reasoning, reconsider differential diagnoses, enact a plan) method is an efficient, recallable checklist that uses an educational approach to reduce diagnostic error while reminding us to simply "care" from a humanistic perspective. This method may help reduce preventable diagnostic errors and improve patient care.