Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice

Abstract

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.

Development of the conversation tool “I-HARP for COPD” for early identification of palliative care needs in patients with chronic obstructive pulmonary disease

“…As a result of the focus groups, 14 individual palliative care themes were ultimately included in the test version of "I-HARP for COPD". Both the original "I-HARP" and "I-HARP for COPD" share 12 of the same palliative care themes (Ament et al 2020), demonstrating that there are overall comparable palliative care needs between each chronic condition (Kowalczys et al 2022;Siouta et al 2019). Both the in-depth questions (89.6%) and the care recommendations (93.1%) were accepted by HCPs.…”

“…Although patients with serious COPD and CHF share palliative care needs (Finamore et al 2021), disease-specific palliative care needs in COPD require adaptation of "I-HARP" (Kowalczys et al 2022;Siouta et al 2019). Indeed, some palliative care needs are more common in patients with COPD than in patients with CHF, such as needs related to anxiety (Kowalczys et al 2022) and dyspnea (Janssen et al 2011). Therefore, this study aimed to develop "I-HARP for COPD" to early identify, discuss, and address palliative care needs in patients with serious COPD.…”