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Review
. 2024;20(11-12):661-668.
doi: 10.1080/14796678.2024.2404323. Epub 2024 Sep 30.

Proactive approaches in congestive heart failure: the significance of early goals of care discussion and palliative care

Bhupinder Singh  1 , Meet A Patel  2 , Shreya Garg  3 , Vasu Gupta  3 , Amishi Singla  4 , Rohit Jain  5
Affiliations
Review

Proactive approaches in congestive heart failure: the significance of early goals of care discussion and palliative care

Bhupinder Singh et al. Future Cardiol. 2024.

Abstract

Congestive Heart Failure (CHF) poses significant challenges to the healthcare system due to its high rates of morbidity and mortality as well as frequent readmissions. All of these factors contribute to increased healthcare delivery costs. Besides the burden on the healthcare system, CHF has far deeper effects on the patient in terms of psychological burden along with debilitating symptoms of dyspnea, all of which reduce quality of life. Prognostic awareness among patients about their disease along with initiating early goals of care discussion by those involved in the care (physicians, nurses, social worker and patient themselves) can help mitigate these challenges. Adopting a proactive approach to address patient preferences, values and end-of-life goals improves patient-centred care, enhances quality of life and reduces the strain on healthcare resources. In this narrative review, studies have been identified using PubMed search to shed knowledge on what is preventing the initiation of goals of care discussions. Some barriers include lack of knowledge about prognosis in both patients and caregivers, inexperience or discomfort in having those conversations and delaying it until CHF becomes too advanced.

Keywords: congestive heart failure; end of life care; goals of care; hospice care; hospitalization; palliative care; social work.

Plain language summary

Heart disease is the leading cause of death in the United States and by 2030, around 8.5 million people are expected to suffer from heart failure due to increasing rates of obesity, diabetes, smoking, high blood pressure and coronary heart disease. People with heart failure often have severe physical symptoms and emotional distress, which affects their quality of life. Palliative care, which aims to relieve symptoms and provide support, is essential for these patients and their families. It helps improve communication about the disease, reduces hospital readmissions and increases the chances of patients enrolling in hospice care. However, discussions about end-of-life care often do not happen in time or at all for heart failure patients. There are many barriers, including physician's inability to explain the downsides of life-sustaining treatments and patients and families struggling to accept the poor prognosis of the disease. It's important to develop scoring systems, like the Gagne Combined Comorbidity score, to help physicians identify patients at risk of poor outcomes and start end-of-life care discussions early. Signs that a patient might need palliative care include frequent hospital visits, severe ongoing symptoms and advanced treatments. Despite its importance, many heart failure patients do not receive timely palliative care. Early discussions about care preferences, integrating palliative care into regular treatment, and timely hospice referrals can greatly improve the quality of life for these patients and their families.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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