Palliative Care in Congestive Heart Failure

Abstract

Symptoms and compromised quality of life prevail throughout the course of heart failure (HF) and thus should be specifically addressed with palliative measures. Palliative care for HF should be integrated into comprehensive HF care, just as evidence-based HF care should be included in end-of-life care for HF patients. The neurohormonal and catabolic derangements in HF are at the base of HF symptoms. A complex set of abnormalities can be addressed with a variety of interventions, including evidence-based HF care, specific exercise, opioids, treatment of sleep-disordered breathing, and interventions to address patient and family perceptions of control over their illness. Both potential sudden cardiac death and generally shortened length of life by HF should be acknowledged and planned for. Strategies to negotiate communication about prognosis with HF patients and their families can be integrated into care. Additional evidence is needed to direct care at the end of life, including use of HF medications, and to define management of multiple sources of distress for HF patients and their families.

Palliative care in heart failure: facts and numbers

“…The need to increase the emphasis on palliative and end‐of‐life care has been identified as a policy recommendation that is necessary to improve care to patients with heart failure: a document endorsed by the HFA alongside 49 national heart failure working groups 6. However, this will require several challenges to be overcome.…”

“…Of those patients who survive their index presentation, many exhibit a period of relative stability following initial diagnosis and the establishment of evidence‐based therapy. Thereafter, the clinical course is generally one of gradual decline, punctuated by episodes of acute decompensation, which usually increase in frequency and complexity as cardiac function deteriorates 6. There is an ever‐present risk of sudden death, although this tends to be more common in the earlier phase of the disease and in those with underlying coronary disease.…”

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…While recent evidence suggests modest improvements in HF-related outcomes (150), the care provided to many HF patients, particularly those who are elderly, still fails to meet the standards set out in the CCS recommendations on HF (151)(152)(153)(154)(155). Applying quality assurance methods to chronic HF requires consideration of the often unpredictable illness trajectory, characterized by periods of relative stability that are punctuated by episodes of acute decompensation (156). This may be conceptualized as in Figure 2, which illustrates the HF cycle, components of which are potential objects for quality assurance, and which include the following:…”

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.…”