Palliative Care in Heart Failure: Rationale, Evidence, and Future Priorities

Abstract

Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.

Keywords: heart failure; hospice; palliative care; quality of care; quality of life.

Published by Elsevier Inc.

Figures

Central Illustration. Integrating Palliative Care Across the Heart Failure Experience

Core domains of primary palliative care (e.g., symptom assessment and management, psychosocial support, advance care planning) may be seamlessly integrated within usual HF disease and device management. When appropriate, specialty palliative care services may be initiated to address complex or intractable palliative needs. The timing of these referrals should be based on patient need, not prognosis, and can be initiated at any point during the HF trajectory. Stars depict key events, such as acute decompensation or hospitalization, which may be particularly salient opportunities for evaluation of appropriateness for specialty palliative care referral or hospice referral, if aligned with a patient’s goals. Given that symptoms, functional status, and QoL are not perfectly correlated, it is important that palliative needs such as symptoms and QoL be routinely and systematically monitored throughout the patient’s HF care trajectory.