Sarah Chuzi1, Esther S Pak2, Akshay S Desai3,4, Kristen G Schaefer4,5,6, Haider J Warraich7,8,9. 1. Division of Cardiology, Department of Medicine, Northwestern University at Feinberg School of Medicine, Chicago, IL, USA. 2. Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 3. Center for Advanced Heart Disease, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. 4. Harvard Medical School, Boston, MA, USA. 5. Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA. 6. Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, USA. 7. Center for Advanced Heart Disease, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. hwarraich@partners.org. 8. Harvard Medical School, Boston, MA, USA. hwarraich@partners.org. 9. Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, MA, USA. hwarraich@partners.org.
Abstract
PURPOSE OF REVIEW: Patients with heart failure (HF) have an increased symptom burden and complex psychosocial and decision-making needs that necessitate the integration of palliative care. However, in the current era, palliative care is frequently evoked for these patients only at the end-of-life or in the inpatient setting; rarely is palliative care proactively utilized in outpatients with HF. The purpose of this review is to evaluate the current state of palliative care and heart failure and to provide a roadmap for the integration of palliative care into outpatient HF care. RECENT FINDINGS: Recent studies, including PAL-HF, CASA, and SWAP-HF, have demonstrated that structured palliative care interventions may improve quality of life, depression, anxiety, understanding of prognosis, and well-being in HF. HF is associated with high mortality risk, significant symptom burden, and impaired quality of life. Palliative care can meet many of these needs; however, in the current era, palliative care consultations in HF occur late in the disease course and too often in the inpatient setting. Primary palliative care should be provided to all outpatients with heart failure based on their needs, with referral to secondary palliative care provided based on certain triggers and milestones.
PURPOSE OF REVIEW: Patients with heart failure (HF) have an increased symptom burden and complex psychosocial and decision-making needs that necessitate the integration of palliative care. However, in the current era, palliative care is frequently evoked for these patients only at the end-of-life or in the inpatient setting; rarely is palliative care proactively utilized in outpatients with HF. The purpose of this review is to evaluate the current state of palliative care and heart failure and to provide a roadmap for the integration of palliative care into outpatientHF care. RECENT FINDINGS: Recent studies, including PAL-HF, CASA, and SWAP-HF, have demonstrated that structured palliative care interventions may improve quality of life, depression, anxiety, understanding of prognosis, and well-being in HF. HF is associated with high mortality risk, significant symptom burden, and impaired quality of life. Palliative care can meet many of these needs; however, in the current era, palliative care consultations in HF occur late in the disease course and too often in the inpatient setting. Primary palliative care should be provided to all outpatients with heart failure based on their needs, with referral to secondary palliative care provided based on certain triggers and milestones.
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