Heart Failure and Palliative Care: Implications in Practice

Abstract

The numbers of people with heart failure is continually rising. Despite continued medical advances that may prolong life, there is no cure. While typical heart failure trajectories include the risk of sudden death, heart failure is typically characterized by periods of stability interrupted by acute exacerbations. The unpredictable nature of this disease and the inability to predict its terminal phase has resulted in few services beyond medical management being offered. Yet, this population has documented unmet needs that extend beyond routine medical care. Palliative care has been proposed as a strategy to meet these needs, however these services are rarely offered. Although palliative care should be implemented early in the disease process, in practice it is tied to end-of-life care. The purpose of this study was to uncover whether the conceptualization of palliative care for heart failure as end-of-life care may inhibit the provision of these services. The meaning of palliative care in heart failure was explored from three perspectives: scientific literature, healthcare providers, and spousal caregivers of patients with heart failure. There is confusion in the literature and by the health care community about the meaning of the term palliative care and what the provision of these services entails. Palliative care was equated to end-of-life care, and as a result, healthcare providers may be reluctant to discuss palliative care with heart failure patients early in the disease trajectory. Most family caregivers have not heard of the term and all would be receptive to an offer of palliative care at some point during the disease trajectory.

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

“…2,[12][13][14][15] This seems logical, since persons with advanced HF and their families, like patients with cancer, bear the brunt of unaddressed physical pain and emotional suffering, face a number of complex and difficult medical decisions, 2 and weather multiple hospitalizations in their last year of life. 7,9,[16][17][18][19][20][21] Initiation of interdisciplinary palliative care services beginning early in the course of advanced HF has been strongly recommended as a critical strategy in addressing these challenges by professional groups 6,15,19,[25][26][27][28][29] including the AHA 25 and many others. 5,15,22,23 However, few PC models have undergone systematic development and testing to address the individualized needs of patients with advanced HF and their family caregivers, especially for those in community-based rural locations where geographic distances and access to care can present significant challenges.…”

“…In addition, patients receive an in-person PC team assessment based on National Consensus Project PC guidelines. 22 ENABLE [21][22][23] is the first successful PC intervention in the rural advanced cancer population to apply Wagner's Chronic Illness Care (CIC) model, [24][25][26][27][28][29][30] which shifted the cancer care paradigm by introducing concurrent PC earlier in the disease trajectory (see Fig. 3).…”

A palliative care approach in heart failure: knowledge and attitudes of cardiac nurses

“…In fact, HF experts recommend that palliative care should be integrated through all stages of HF care as it is a supportive intervention for both patients and families (Hupcey et al, 2009;Jaarsma et al, 2009). The reality remains, however, few HF patients receive any palliative care services (O'Leary & Tiernan, 2008).…”

“…The reality remains, however, few HF patients receive any palliative care services (O'Leary & Tiernan, 2008). Lack of knowledge and misconceptions about palliative care have been reported among HF specialists with Hupcey et al (2009) noting that both doctors and nurses in specialised HF centres believed that introducing palliative care was synonymous with pre-death care.…”

Early Palliative Care: Taking Ownership and Creating the Conditions

“…Kain and Eisenhauer, in this edition of Current Oncology, add a noteworthy voice to the call for action. Notably, that call is neither new nor confined to cancer care; the need to provide palliative care and to initiate it earlier in the illness trajectory is echoing ever louder, to include many non-cancer conditions ranging from advanced heart, lung, liver, renal, and neurologic diseases to conditions such as dementia and frailty [1][2][3][4] .…”