Palliative care in heart failure: facts and numbers

Abstract

Millions of people worldwide have heart failure. Despite enormous advances in care that have improved outcome, heart failure remains associated with a poor prognosis. Worldwide, there is poor short‐term and long‐term survival. The 1 year survival following a heart failure admission is in the range of 20–40% with between‐country variation. For those living with heart failure, the symptom burden is high. Studies report that 55 to 95% of patients experience shortness of breath and 63 to 93% experience tiredness. These symptoms are associated with a high level of distress (43–89%). Fewer patients experience symptoms such as constipation (25–30%) or dry mouth (35–74%). However, when they do, such symptoms are associated with high levels of distress (constipation: 15–39%; dry mouth: 14–33%). Psychological symptoms also predominate with possibly as many as 50% experiencing depression. Palliative care services in heart failure are not widely available. Even in countries with well‐developed services, only around 4% of patients are referred for specialist palliative care. Many patients and their families would benefit from receiving specialist palliative care support.

Recent advances in cardio‐oncology: a report from the ‘Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019’

“…21, 22 Depending on the cancer diagnosis and the type of anti-cancer treatment, cardiotoxicity rates may vary from 0% to 48% of patients, with HF being a predominant presentation. 27 HF is characterized by multiple symptoms such as reduced physical performance, 28 shortness of breath, 29 fluid retention, 30 general weakness 31 , and prolonged hospital stays 32 , which ultimately also result into substantial healthcare costs. 27 HF is characterized by multiple symptoms such as reduced physical performance, 28 shortness of breath, 29 fluid retention, 30 general weakness 31 , and prolonged hospital stays 32 , which ultimately also result into substantial healthcare costs.…”

“…23 HF is associated with a 5-year survival rate of nearly 50% [24][25][26] and is frequently accompanied by reduced quality of life. 27 HF is characterized by multiple symptoms such as reduced physical performance, 28 shortness of breath, 29 fluid retention, 30 general weakness 31 , and prolonged hospital stays 32 , which ultimately also result into substantial healthcare costs. 33 Besides HF, other frequent cardiovascular (CV) problems associated with anti-cancer therapies include coronary artery disease, 34 atrial fibrillation, 35 arterial hypertension, 36 thromboembolic disease 37 , valvular disease 38 , pulmonary hypertension, 39 stroke, 40 and peripheral vascular disease.…”

Cancer and heart failure—more than meets the eye: common risk factors and co‐morbidities

“…In the industrialized world about 4% of all medical expenditure is related to anti‐cancer and more than 2% to heart failure treatments . Cancer and heart failure are interrelated on many levels, share some of the same risk factors such as hypertension, obesity, diabetes, and tobacco smoking, and frequently show similar symptoms such as fatigue, dyspnoea, weight loss, muscle wasting, and oedema . Furthermore, several modern anti‐cancer therapies can cause transient or permanent left ventricular dysfunction (defined as a reduction of left ventricular ejection fraction by more than 10 percentage points and under 50%) in up to 48% of patients, depending on the kind of chemo‐, immuno‐ or radio‐therapy selected and the dose provided.…”

Persistently misunderstood and malignant: the case of heart failure vs. cancer

“…At the same time, we can use readily identifiable comparisons with cancer to educate the public about heart failure in order to correct persistent misperceptions. We can also advocate for equivalent health services for those unfortunate to be affected by the syndrome, such as palliative care services being a high priority for those unfortunate enough to develop end‐stage heart failure …”

“…We can also advocate for equivalent health services for those unfortunate to be affected by the syndrome, such as palliative care services being a high priority for those unfortunate enough to develop end-stage heart failure. 13 Conflict of interest: none declared.…”