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Teachable Moment
Less Is More
June 2015

The Importance of Cognitive Assessment Before Ventricular Device PlacementA Teachable Moment

Author Affiliations
  • 1Department of Geriatrics, University of California, San Francisco
  • 2Division of Cardiology, University of California, San Francisco
JAMA Intern Med. 2015;175(6):890. doi:10.1001/jamainternmed.2015.0468

A 76-year-old man with systolic heart failure presented to the advanced heart failure service after optimal medical management including biventricular pacing failed to improve his symptoms. A left ventricular assist device (LVAD) as destination therapy was offered to the patient after he was determined not to be a transplant candidate owing to advanced age. The risks and benefits of such a device were discussed with the patient and his family. Although the family had noticed some subtle hints of changes in his memory, such as repeating questions, word-finding difficulties, and missing appointments, these issues were not brought to the attention of the medical team, nor were they evident during multiple clinical encounters. Formal cognitive testing was not documented.

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