Improving Primary and Specialist Palliative Care in Cardiovascular Disease

Abstract

Palliative care (PC) focuses on improving quality of life for people with severe illness of any age. Palliative care can be provided by a multidisciplinary team of PC specialists or by other health care professionals as primary or basic PC. Palliative care can be provided concurrent with life-prolonging or curative care as needed from time of diagnosis. In contrast, hospice (as defined in the United States) is a form of PC focused on providing comfort to people with an estimated prognosis of 6 months or less. Two 2017 systematic reviews 1,2 present early evidence of the benefit of PC in cardiovascular disease (CVD), particularly for patients with heart failure. Warraich et al 3 conducted a retrospective study using a PC registry to understand changes in characteristics and trends among 1801 patients with CVD referred to PC specialists during a 3-year period, from 2015 through 2017. The main question was whether patients with CVD were seen earlier in the disease trajectory over time, measured using the palliative performance score, a health care professional-rated measure of functional status. Warraich et al 3 found that 28.9% of patients (521 of 1801) had low palliative performance scores, consistent with being bedbound and requiring total care. This percentage did not change through time. Patients reported moderate to severe symptoms, including poor well-being, tiredness, anorexia, dyspnea, and pain. The study identified some changes from 2015 to 2017, including a reduced proportion of black patients (11.9% in 2015 vs 6.3% in 2017), an increased proportion of coronary artery disease and valvular heart disease diagnoses (25.6% in 2015 vs 30.1% in 2017), and a reduced proportion of referrals from cardiologists (16.5% in 2015 vs

Towards the Provision of Palliative Care Services in the Intensive Coronary Care Units: Nurses’ Knowledge, Training Needs, and Related-Barriers

“…The disease trajectory of most CVDs warrants the inclusion of PC services either at the acute or end-of-life stages. Despite the notable benefits of PC in CVDs (particularly heart failure) and the enormous burden of CVDs, the utilization of PC to improve the health of cardiac disease patients remains low [ 6 ].…”