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Palliative care for patients with advanced heart failure: Indications and strategies

Author
Larry Allen, MD, MHS
Section Editors
Sharon A Hunt, MD
R Sean Morrison, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Despite advances in cardiac therapy, heart failure remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, clinicians, and health care systems. Palliative care is an interdisciplinary approach to care that focuses on improving quality of life for patients and families facing serious illness. Palliative care has a role across the stages of heart failure, starting early in the course of illness, intensifying in end-stage disease, and extending into caregiver bereavement.

Indications, estimation of prognosis, and strategies for palliative care in patients with advanced heart failure will be reviewed here. Advanced care planning, symptom management, and psychosocial support for patients with advanced heart failure and the general management of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction are discussed separately. (See "Palliative care for patients with advanced heart failure: Decision support, symptom management, and psychosocial assistance" and "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction".)

OBJECTIVES, AND COMPONENTS

Palliative care is an interdisciplinary approach to care that focuses on improving quality of life for patients and their families. Objectives of palliative care include relieving pain and other distressing symptoms, integration of medical, psychological and spiritual aspects of care, and offering a support system to help families cope during illness and bereavement. Greater integration of palliative care in the management of heart failure has the potential to facilitate coping with clinical uncertainty, to promote patient-centered care that bridges silos of care for coordinated management of comorbidities, to improve communication, and to assist shared decision making regarding use of life-saving devices with complex trade-offs.

Key components of palliative care include exploring patients’ understanding about their illness, discussing prognosis, clarifying goals of care, navigating treatment options, coordinating care, and helping to plan end-of-life care, including determining the need and timing of hospice care.

PALLIATIVE CARE TYPES AND INDICATIONS

Because heart failure is a highly symptomatic disease with complex decision making and a relatively high risk for death throughout its course, palliative care should be integrated early and often into the care of these patients. However, certain palliative care approaches may have greater applicability at different points in the disease and the overall intensity of palliative care needs tends to increase over time. Multiple practice guidelines and scientific statements recommend the use of palliative care in patients with heart failure [1-9].

                              

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Literature review current through: Feb 2017. | This topic last updated: Tue Mar 07 00:00:00 GMT+00:00 2017.
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