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Management strategies Key points
• Management options included upgrade from ICD
to CRT-D in a patient with advanced heart failure
in the setting of progressive DMD. Other possible
therapies included mechanical support devices and
transplantation.
• Values elicited in discussion were the role of the
patient (still a minor) and parents in the shared
decision-making, and assessment of the balance of
benefit of more aggressive device therapy.
• Decision for management and rationale were driven
by the progressive nature of the NMD complicated
with heart failure. The use of intravenous inotropes
afforded the patient some improvement in heart
failure symptoms.
• Although upgrade of an
ICD in most contexts is
reasonably safe, this was not
the case here.
• Shared decision-making
should include the patient
even if he/she is a minor.
• Optimization of quality of
life, even if limited in time, is
paramount.
