Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement

Abstract

Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.

Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis

“…The results of this review are concordant with the recent European Association for Palliative Care (EAPC) position statement where a comprehensive palliative care needsassessment tool was suggested to identify patients with unmet needs [9]. NAT:PD-HF, being validated for patients with heart failure, was suggested as an example of such a tool but this was not based on detailed comparisons with other tools.…”

“…The choice of the most appropriate tools was based on comprehensive comparisons according to predetermined criteria. Although NAT:PD-HF was suggested as an example of a good needs-assessment tool in the EAPC statement and another review, this was not based on such comparisons [9,18].…”

“…Patients with heart failure have a significant symptom burden and palliative care needs [4,5], which are comparable with those with cancer [6,7]. Several guidelines call for integrating palliative care into standard heart failure management [8][9][10]. Providing palliative care to these patients results in an improvement in their physical and psychological symptoms, quality of life, and satisfaction; increase in documentation of care preferences; and decrease in the use of medical service [11][12][13].…”

Unmet device reprogramming needs at the end of life among patients with implantable cardioverter defibrillator: A systematic review and meta-analysis

“…Since the 2010 publication of the EHRA and the HRA statements, others have also recommended discussing implantable cardioverter defibrillator reprogramming in patients nearing the end of life. 2,30 Although protocols now guide physicians and healthcare providers through the deactivation process step by step, 31,32 our review found only a 28% pooled prevalence of implantable cardioverter defibrillator reprogramming at the end of life. Across studies, prevalence ranged from 15% to 52%, and almost all of the device reprogramming happened in a hospital setting, with fewer in hospices and nursing homes, and very few in patients at home.…”

Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion

“…This last point is essential, as palliative care is frequently suboptimal in elderly patients with other conditions, such as heart failure, and this is probably the case in COVID-19. 2,9,10…”