Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

Abstract

Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure‐orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.

Palliative care in heart failure: facts and numbers

“…Palliative care is recognized in international heart failure guidelines 11, 27. The Heart Failure Association (HFA) of the ESC issued a position statement in 2009,28 and the most recent ESC heart failure guidelines of 2016 acknowledge the value of including palliative care but stop short of providing a recommendation with a level of evidence 11. In contrast, the 2013 heart failure guidelines from the American Heart Association and American College of Cardiology recommend palliative care to improve quality of life in symptomatic patients based on perceived patient benefit.…”

Quality of life and symptoms of depression in advanced heart failure patients and their partners

“…Interventions aimed at alleviating symptoms should be directed at the patients' physiological and psychological symptoms, but also address their social and spiritual needs (2). Symptom control in end-stage HF poses specific challenges.…”

“…Compared to the last decades, patients live longer with heart failure (HF), however their daily life is often marked by significant symptoms and side-effects of the treatment affecting not only the physical dimensions of life, but also social and psychological dimensions during the disease trajectory (1)(2)(3). A poor quality of life and depressive symptoms have been described to lead to an increased risk of hospital admissions and death (4,5).…”

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

“…2,[12][13][14][15] This seems logical, since persons with advanced HF and their families, like patients with cancer, bear the brunt of unaddressed physical pain and emotional suffering, face a number of complex and difficult medical decisions, 2 and weather multiple hospitalizations in their last year of life. 7,9,[16][17][18][19][20][21] Initiation of interdisciplinary palliative care services beginning early in the course of advanced HF has been strongly recommended as a critical strategy in addressing these challenges by professional groups 6,15,19,[25][26][27][28][29] including the AHA 25 and many others. 5,15,22,23 However, few PC models have undergone systematic development and testing to address the individualized needs of patients with advanced HF and their family caregivers, especially for those in community-based rural locations where geographic distances and access to care can present significant challenges.…”