Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Feb 19;7(1):30.
doi: 10.3390/healthcare7010030.

The Role of Palliative Care in the Cardiac Intensive Care Unit

Massimo Romano'  1
Affiliations
Review

The Role of Palliative Care in the Cardiac Intensive Care Unit

Massimo Romano'. Healthcare (Basel). .

Abstract

In the last few years, important changes have occurred in the clinical and epidemiological characteristics of patients that were admitted to cardiac intensive care units (CICU). Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden and mortality rate and an increased length of stay. In this context, palliative care programs, including withholding/withdrawing life support treatments or the deactivation of implanted cardiac devices, are frequently needed, according to the specific guidelines of scientific societies. However, the implementation of these recommendations in clinical practice is still inconsistent. In this review, we analyze the reasons for this gap and the main cultural changes that are required to improve the care of patients with advanced illness.

Keywords: cardiac intensive care unit (CICU); end of life care; heart failure; intensive care unit; palliative care; withdrawing treatment; withholding treatment.

PubMed Disclaimer

Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
The arrows indicate exacerbation phases in organ failure associated with the risk of dying. The course of the disease may be stopped by sudden death (SD).
Figure 2
Figure 2
Modified from Sulmasy [60].
Figure 3
Figure 3
Factors affecting Proportionality of treatments.
See this image and copyright information in PMC

References

    1. Pivodic L., Pardon K., Morin L., Addington-Hall J., Miccinesi G., Cardenas-Turanzas M., Onwuteaka-Philipsen B., Naylor W., Ruiz Ramos M., Van den Block L., et al. Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries. J. Epidemiol. Community Health. 2016;70:17–24. doi: 10.1136/jech-2014-205365. - DOI - PubMed
    1. Broad J.B., Gott M., Kim H., Boyd M., Chen H., Connolly M.J. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int. J. Public Health. 2013;58:257–267. doi: 10.1007/s00038-012-0394-5. - DOI - PubMed
    1. Angus D., Barnato A.E., Linde-Zwirble W.T., Weissfeld L.A., Watson R.S., Rickert T., Rubenfeld G.D., Robert Wood Johnson Foundation ICU End-Of-Life Peer Group Use of intensive care at the end of life in the United States: An epidemiologic study. Crit. Care Med. 2004;32:638–643. doi: 10.1097/01.CCM.0000114816.62331.08. - DOI - PubMed
    1. Teno J.M., Gozalo P.L., Bynum J.P., Leland N.E., Miller S.C., Morden N.E., Scupp T., Goodman D.C., Mor V. Change in end-of-life care for Medicare beneficiaries: Site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309:470–477. doi: 10.1001/jama.2012.207624. - DOI - PMC - PubMed
    1. Halpern N.A., Goldman D.A., Tan K.S., Pastores S.M. Trends in Critical Care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000–2010. Crit. Care Med. 2016;44:1490–1499. doi: 10.1097/CCM.0000000000001722. - DOI - PMC - PubMed

LinkOut - more resources