Palliative Care and Hospice in Advanced Heart Failure

Abstract

This paper provides an evidence-based review of the principles underlying palliative care for heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment. Approaches to advanced care planning, symptom management, hospice eligibility, home inotropic infusions, device management and improving the continuum of care in HF are discussed. The reader will be able to recognize advanced HF, use important elements of physical assessment, utilize Web-based prognostic and risk-stratification models, facilitate advance care planning, ensure optimal treatment, manage common symptoms and comorbid conditions, determine hospice eligibility, and consider issues related to withholding or withdrawal of inotropic infusions and devices used in HF refractory to standard treatment. The ultimate goal of palliative care for heart failure is to integrate knowledge of treatment advances and comfort measures and to provide them concurrently in a seamless continuum to patients with late-stage disease.

Difficult conversations and chronic heart failure: do you talk the talk or walk the walk?

“…We can also be reassured by the increasing numbers of people with cancer who have been able to deal with bad news successfully and continue to lead fulfilling lives amidst uncertainty [42]. Perhaps, what is more important for clinicians to consider in the heart failure trajectory, is that the 'difficult conversation' is not a single discussion; rather, providing bad news, discussing prognosis and presenting treatment options are generally interrelated processes and should be undertaken in a series of ongoing conversations [32]. All issues may need to be discussed to a greater or lesser extent, from the initial diagnosis, when bad news is broken, through to later consultations when more information is available about treatment options [43].…”

Edgar Allan Poe, “The Pit and the Pendulum,” and Ventricular Assist Devices

“…3,17 For patients with intractable signs and symptoms, a heart transplant, the reference standard for cardiac replacement, 18,19 is the only established surgical approach. 13 In the United States, however, the number of patients awaiting heart transplantation is much greater than the number of available donors.…”

Increasing Palliative Consults for Heart Failure Inpatients Using the Seattle Heart Failure Model

“…The rationale for this decision is that discussing the patient's preferences for care needs to occur directly with the patient; therefore, this discussion must take place early enough in the disease trajectory for the patient to be an active participant in the discussion. 32 Future research is planned to determine if implementing this tool in the acute-care setting helps heighten awareness about the progressive nature of HF and increases appropriate EOL care planning for this population.…”