Integrating Palliative Care Into Heart Failure Care

Abstract

Heart failure is a condition for which both palliative care and hospice care can be appropriate. The disease's increasing prevalence and predilection for elderly patients with significant comorbidity underscore the need to integrate these modes of care with the acute care approach that has dominated heart failure treatment. We propose integration of a palliative care approach early in the course of heart failure treatment and a tiered process for selecting patients for hospice care. A transition of the focus to palliative care rather than mortality reduction should occur over time, when clinical status deteriorates and advanced therapeutic options become inappropriate or ineffective. Failure to respond to the need for palliative care puts at risk the mandate to treat the patient with heart failure during the entire course of illness.

Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients

“…Little researchbased evidence exists to guide practitioners on which patients with heart failure might be appropriate to receive palliative care, and when it should be provided, especially given the association of palliative care with end of life care. 16,[37][38][39][40][41][42][43][44][45][46][47][48] The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult generally equates palliative care with hospice and primarily discusses it in the context of end of life care. 49 However, palliative care can be understood as care that should be provided from the time of diagnosis of a serious illness, which is often much earlier than when patients are eligible for hospice or at the end of life.…”

Early Integration of Palliative Care into Standard Oncology Care: Evidence and Overcoming Barriers to Implementation

“…That concern is amplified by the recognition that early palliative care involvement and expertise benefits not only cancer patients, but also patients with life-limiting nonmalignant disease such as congestive heart failure and chronic obstructive pulmonary disease 16,17 .…”

Palliative Care in the Treatment of Advanced Heart Failure

“…Guidelines do not specifically address when to refer end-stage heart failure patients for hospice/nonhospice palliative care. 40 Unlike many cancers, which are characterized by a steep linear decline in performance status during the last few months of life, heart failure is characterized by unpredictable decompensations and improvements, with a subtler decline over time. 41,42 This makes it difficult for doctors to recognize when it is appropriate to refer a patient to hospice.…”