p.63 抽出テキスト

.................................................................

12 Patient-centred care and shared decision-making in cardiac pacing and cardiac resynchronization therapy Providing patient-centred care is a holistic process that emphasizes partnerships in health between patient and clinician, acknowledging the patient’s needs, beliefs, expectations, healthcare preferences, goals, and values.811813 In patient-centred care, the focus is on shared decision-making, accepting that patients generally prefer to take an active role in decisions about their health.814,815 This approach has been shown to improve health outcomes and healthcare experiences.814,816 Clinicians have a duty to define and explain the healthcare problem and make recommendations about the best available evidence across all available options at the time, including no treatment, while ensuring that the patient’s values and preferences are considered (Figure 16).817820 Decision aids, such as written information and/or the use of interactive websites or web-based applications, can complement the clinicians’ counselling and thus facilitate shared decision-making.822 When decision aids are used, patients feel more knowledgeable, have more accurate risk perceptions, and take a more active part in the decision.823 In patients with poor language or literacy skills, as well as in those with cognitive impairment, communication strategies, including the help of a qualified interpreter, is recommended, as this helps the patient to make a balanced decision.824826 Choosing the appropriate educational material is an important component of promoting the learning process of patients.827830 Based on the patient’s needs and preferences, the education should be performed before implantation, at discharge, and during follow-up using a person-centred approach (Table 14). All patients should receive a brochure provided by the manufacturer as well as a device identification card before discharge.

This Task Force emphasizes the importance of patient-centred care and shared decision-making between patients and clinicians. The decision to implant a pacemaker/CRT should be based on the best available evidence with consideration of the individual riskbenefits of each option, the patient’s preferences, and goals of care. The consultation should include whether the patient is a good candidate for pacemaker/CRT treatment, and possible alternative treatment options should be discussed in a way that can be understood by everyone involved in the discussion. Using the principles of shared decision-making and informed consent/refusal, patients with decision-making capacity have the right to refuse pacemaker therapy, even if they are pacemaker dependent.

13 Quality indicators

Quality indicators are tools that may be used to evaluate care quality, including that of processes of care and clinical outcomes.837 They may also serve as a mechanism for enhancing adherence to guideline recommendations through quality assurance endeavours and benchmarking of care providers.838 As such, the role of quality indicators in driving quality improvement is increasingly recognized and attracts interest from healthcare authorities, professional organizations, payers, and the public.839 The ESC recognizes the need for measuring and reporting quality and outcomes of cardiovascular care. One aspect of this is the development and implementation of quality indicators for cardiovascular disease. The methodology by which the ESC quality indicators are

Recommendations for pacemaker and cardiac resynchronization therapy-pacemaker follow-up

Recommendations Classa Levelb

Remote device management is recommended to reduce the number of in-office follow-ups in patients with pacemakers who have difficulties to attend in-office visits (e.g. due to reduced mobility or other commitments, or according to patient preference).805,806,809 I A Remote monitoring is recommended in the case of a device component that has been recalled or is on advisory, to enable early detection of actionable events in patients, particularly those who are at increased risk (e.g. in the case of pacemaker dependency). I C In-office routine follow-up of single- and dualchamber pacemakers may be spaced by up to 24 months in patients on remote device management.805,806 IIa A Remote device management of pacemakers should be considered in order to provide earlier detection of clinical problems (e.g. arrhythmias) or technical issues (e.g. lead failure or battery depletion).806,810 IIa B

aClass of recommendation. bLevel of evidence. ESC 2021 Recommendation regarding patient-centred care and shared decision-making in cardiac pacing and cardiac resynchronization therapy

Recommendation Classa Levelb

In patients considered for pacemaker or CRT, the decision should be based on the best available evidence with consideration of individual riskbenefits of each option, the patient’s preferences, and goals of care, and it is recommended to follow an integrated care approach and use the principles of patient-centred care and shared decision-making in the consultation.831836 I C

CRT = cardiac resynchronization therapy. aClass of recommendation. bLevel of evidence. ESC 2021

............................................................................................................ Downloaded from academic.oup.com/eurheartj/article/42/35/3427/6358547 by guest on 07 October 2026