Table 3.

Individualized and Careful Approach to Cardiac Medications.

Patient-centered decision making	Sometimes with these very hopeful patients, having the medications is the only control they have left. So, we will work with that. We do not routinely stop medications without a lot of conversation. Until [patients self-discontinue medications], we do not have a situation in our program where someone comes in and says, “Okay you can’t take any of your heart medications.”
Education and collaboration	[Patients] are on such a regimen of drugs. It is hard to get them to give those up. To our estimation, we feel that they are not getting much benefit from them. To them, they have had a lot of really good clinicians who have entrenched in taking them. It is probably hardest to convince them that [the medications] have probably already done all they are going to do.
Support for inotropes	We will basically do anything in the arsenal . . . up through milrinone, your diuretics, your beta blockers—whatever a cardiologist believes to maintain quality of life.