Palliative Care for Patients With Heart Failure

Abstract

Palliative care should be integrated into routine disease management for all patients with serious illness, regardless of settings or prognosis. The purposes of this integrative review were to identify the features of randomized controlled trials for adult patients with heart failure and to provide basic references for the development of future trials. Using Whittemore and Knafl's integrative literature review method, comprehensive searches of the PubMed, Cochrane Library, CINAHL, EMBASE, and Korean databases were conducted, integrating keywords about heart failure and palliative care interventions. Quality appraisal was assessed using Cochrane risk-of-bias tools. In total, there were 6 trials providing palliative care interventions integrating team-based approaches between palliative care specialists and nonpalliative clinicians, such as a cardiologist, cardiac nurse, and advanced practice nurse across inpatient and outpatient settings. The different types of interventions included home visits, symptom management via phone calls or referral to a specialist team, and the establishment of treatment planning. Patient-reported outcome measures included positive effects of palliative interventions on symptom burden and quality of life. Given that most of the selected studies were conducted in Western countries, palliative care should be culturally tailored to assist heart failure patients worldwide. KEY WORDSadvance care planning, chronic disease, heart failure, palliative care, review T he prevalence of heart failure (HF) continues to increase with an increase in the aging population. 1 The American Heart Association has reported that 50% of patients diagnosed as having HF die within 5 years, and 5% are at the end of life with a condition refractory to medical treatment. 1 Patients with HF have a significant burden of symptom clusters, including pain, fatigue, dyspnea, depression, anxiety, insomnia, and loss of appetite, causing deterioration in overall quality of life. 2 This imposes an economic and structural burden on patients and their families, as well as the social health care delivery system caring for them. 3 The treatment and management of patients with HF require the consideration of combined physical, psychosocial, and environmental factors. 4 For instance, medical devices such as pacemakers and implantable defibrillators may be effective in the early stages of HF, but their benefits may gradually wane as the disease progresses. In addition to the unpredictable prognosis, patients vary in their illness experience and perception toward overall disease management. 5 As HF progresses, responsibility for end-of-life treatment decisions may change according to the patients' or their family's cultural norms and social context. 6 The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (NCP guidelines) defines palliative care (PC) as an interdisciplinary care delivery system designed to anticipate, prevent, and manage severe illness to optimize the quality of life for patients, the...

Medical knowledge in Brazil about palliative care: Integrative systematic review

“…When organizing the selected studies, the need for the inclusion of PC in medical education becomes clear. The above studies show that none of the institutions had this discipline regularly included in their curriculum, despite its importance, as the teaching of palliative care is being recognized worldwide (Who, 2002;Brown et al, 2018, Kim et al, 2022.…”

End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines

“…In the context of HF, PC involves considering combined physical, psychosocial, and environmental factors, such as the use of pacemakers and implantable defibrillators, the unpredictable prognosis of HF, and the perception of overall disease management. 13 A review of selected PC studies in HF showed that life expectancy is 1 of the main considerations in referral to PC services, with additional criteria including New York Heart Association (NYHA) classification and Ejection fraction (EF) value. 13 PC intervention improves the QOL, and current society guidelines recommend early PC integration in HF management, but it remains underutilized in practice.…”

“…13 A review of selected PC studies in HF showed that life expectancy is 1 of the main considerations in referral to PC services, with additional criteria including New York Heart Association (NYHA) classification and Ejection fraction (EF) value. 13 PC intervention improves the QOL, and current society guidelines recommend early PC integration in HF management, but it remains underutilized in practice. 14 It is appropriate at any age and stage of a serious illness and can be provided with curative treatment.…”

Consensus document on palliative care in cardiorenal patients

“…These goals should prioritize the management of symptoms and respect the patient's preferences. They should be accessible from diagnosis to the end of life, and a multidisciplinary approach with effective coordination between specialists, primary care, and PC physicians is crucial ( 34 ) [ Figure 5 ( 35 )].…”