It's Time to Talk: Challenges in Providing Integrated Palliative Care in Advanced Congestive Heart Failure. A Narrative Review

Abstract

Despite evidence that palliative care may improve symptom control and quality of life in patients with advanced congestive heart failure, a multitude of current challenges hinder access to these services. Education, early discussion of prognosis and advance care planning, and multidisciplinary team-based care may be a helpful initial approach as further targeted work addresses these challenges.

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

“…28 Consistent with an American Heart Association guideline, 2 we recommend that palliative approaches occur earlier in the disease process, ideally timing conversations about advance care planning between patients and providers with the initial diagnosis of heart failure. 29,30 Given the potential for improved prognostication and low burden on providers, our study findings indicate that there may be utility in using PPSv2 scores at hospice admission. Future research steps include the evaluation of the PPSv2 as part of informing hospice eligibility at the time of hospital discharge.…”

Communication about the Heart Failure Trajectory in Patients, their Families and Health Care Professionals

“…Health care professionals need to balance discussions about prognosis and end-of-life care with the assurance that they will work with the patient and try to prolong life and improve quality of life (46). The risk of rapid deterioration or sudden cardiac death needs to be acknowledged early on in the illness trajectory.…”

“…They want to be better informed about their prognosis and want to feel that the professionals listen to them (45). Honest and competent delivery of information maximizes the patients' comprehension of their prognosis (46). Equally important, the delivered information should be relevant to the HF patients' actual situation (47).…”

Palliative care for people living with cardiac disease

“…Be flexible, as patient's needs may change during the conversation. 45,50,53,56,57 In most cases, life expectancy in patients with GUCH is still shorter than in the general population. One -third of deaths occur suddenly, whereas the majority of patients die after progressive health deterioration over a few months, mainly of chronic HF.…”