Palliative care and hospice in advanced heart failure

Abstract

Advanced heart failure (HF) is a disease process that carries a high burden of symptoms, suffering, and death. Palliative care can complement traditional care to improve symptom amelioration, patient-caregiver communication, emotional support, and medical decision making. Despite a growing body of evidence supporting the integration of palliative care into the overall care of patients with HF and some recent evidence of increased use, palliative therapies remain underused in the treatment of advanced HF. Review of the literature reveals that although barriers to integrating palliative care are not fully understood, difficult prognostication combined with caregiver inexperience with end-of-life issues specific to advanced HF is likely to contribute. In this review, we have outlined the general need for palliative care in advanced HF, detailed how palliative measures can be integrated into the care of those having this disease, and explored end-of-life issues specific to these patients.

Fig 1

The perfect storm of factors in advanced HF that converge to create a true need for palliative interventions in the care of those with advanced HF.

Fig 2

Intensity of care throughout the time course of the disease spectrum of HF. Palliative therapies should be integrated throughout, intensified as the patient experiences worsening HF, and escalated when the patient transitions to hospice. Important to note is that some traditional therapies may remain even after the patient is enrolled in hospice. Adapted from Lanken et al.

Fig 3

Palliative therapies should be added in a stepwise fashion to traditional therapies and optical medical management of HF. Adapted from Rocker et al.