Decision Making in Advanced Heart Failure

S hared decision making for advanced heart failure has become both more challenging and more crucial as duration of disease and treatment options have increased.High-quality decisions are chosen from medically reasonable options and are aligned with values, goals, and preferences of an informed patient.The top 10 things to know about decision making in advanced heart failure care are listed in Table 1. Why Shared Decision Making?Providers have an ethical and legal mandate to involve patients in medical decisions.Shared decision making recognizes that there are complex trade-offs in the choice of medical care. 1 Shared decision making also addresses the ethical need to fully inform patients about the risks and benefits of treatments. 2 In the setting of multiple reasonable options for medical care, shared decision making involves clinicians working with patients to ensure that patients' values, goals, and preferences guide informed decisions that are right for each individual patient.Grounded in the ethical principle of autonomy, 3 judicial decisions (eg, Cruzan v Missouri Department of Health 4 ) and legislative actions (eg, the Patient Self-Determination Act 5 ) have repeatedly affirmed the rights of patients or duly appointed surrogates to choose their medical therapy from among reasonable options. 6The formal process of informed consent before procedural interventions is an embodiment of this concept in that it underscores the clinician's obligation to ensure that the patient has the opportunity to be informed. 3An informed patient is one who is aware of the diagnosis and prognosis, the nature of the proposed intervention, the risks and benefits of that intervention, and all reasonable alternatives and their associated risks and benefits. 7A major purpose of a high-functioning healthcare system is to provide the resources with which an activated, informed patient can engage in productive discussions with a proactive, prepared healthcare team. 8hared decision making moves beyond informed consent.It asks that clinicians and patients share information with each other and work toward patient-centered decisions aboutThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.