Heart Falliure

Decision Making in Advanced Heart Failure : A Scientific Statement From the American
Heart Association
Larry A. Allen, Lynne W. Stevenson, Kathleen L. Grady, Nathan E. Goldstein, Daniel D.
Matlock, Robert M. Arnold, Nancy R. Cook, G. Michael Felker, Gary S. Francis, Paul J.
Hauptman, Edward P. Havranek, Harlan M. Krumholz, Donna Mancini, Barbara Riegel and
John A. Spertus
Circulation.2012;125:1928-1952; originally published online March 5, 2012;
doi: 10.1161/CIR.0b013e31824f2173
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Downloaded from http://circ.ahajournals.org/ by guest on May 25, 2012AHA Scientific Statement
Decision Making in Advanced Heart Failure
A Scientific Statement From the American Heart Association
Endorsed by Heart Failure Society of America, American Association
of Heart Failure Nurses, and Society for Medical Decision Making
Larry A. Allen, MD, MHS, Co-Chair; Lynne W. Stevenson, MD, Co-Chair;
Kathleen L. Grady, PhD, APN, FAHA, Co-Chair; Nathan E.Goldstein, MD;
Daniel D. Matlock, MD, MPH; Robert M. Arnold, MD; Nancy R. Cook, ScD;
G. Michael Felker, MD, MHS; Gary S. Francis, MD, FAHA; Paul J. Hauptman, MD;
Edward P. Havranek, MD; Harlan M. Krumholz, MD, SM, FAHA; Donna Mancini, MD;
Barbara Riegel, DNSc, RN, FAHA; John A. Spertus, MD, MPH, FAHA; on behalf of the American
Heart Association Council on Quality of Care and Outcomes Research,Council on Cardiovascular
Nursing, Council on Clinical Cardiology, Council on Cardiovascular Radiology and Intervention, and
Council on Cardiovascular Surgery and Anesthesia

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 medicallyreasonable
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 ofmedical 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....