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Review
. 2015 Jan;12(1):57-65.
doi: 10.11909/j.issn.1671-5411.2015.01.007.

Dilemmas in end-stage heart failure

Carol Chen-Scarabelli  1 , Louis Saravolatz  2 , Benjamin Hirsh  3 , Pratik Agrawal  3 , Tiziano M Scarabelli  4
Affiliations
Review

Dilemmas in end-stage heart failure

Carol Chen-Scarabelli et al. J Geriatr Cardiol. 2015 Jan.

Abstract

Heart failure (HF), a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S. National Library of Medicine website (www.pubmed.gov) using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF (worse than that for many cancers), many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society.

Keywords: Ethical dilemmas; Heart failure; Palliative care.

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Figures

Figure 1.
Figure 1.. Heart failure (HF) prevalence in 2010 was estimated at 6.6 million, with projected increase to 9.6 million in year 2030.
Concurrently, the cost of HF has skyrocketed from an estimated 44.6 billion dollars in 2015 to a projected 97 billion dollars in year 2030.
Figure 2.
Figure 2.. Stakeholders in end-of-life care dilemmas in heart failure, with the heart failure patient being the central stakeholder.
Figure 3.
Figure 3.. Dilemmas of various stakeholders in the care of the heart failure patient
See this image and copyright information in PMC

References

    1. Hunt SA, Abraham WT, Chin MH, et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society ACC/AHA 2005 Guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to update the 2001 guidelines for the evaluation and management of heart failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112:e154–e235. - PubMed
    1. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA Guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:1977–2016. - PubMed
    1. Costanzo MR, Mills RM, Wynne J. Characteristics of “Stage D” heart failure: insights from the acute decompensated heart failure national registry longitudinal module (ADHERE LM) Am Heart J. 2008;155:339–347. - PubMed
    1. Heidenreich PA, Albert NM, Allen LA, et al. American Heart Association Advocacy Coordinating Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Stroke Council Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606–619. - PMC - PubMed
    1. Barclay S, Momen N, Case-Upton S, et al. End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis. Br J Gen Pract. 2011;61:e49–e62. - PMC - PubMed

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