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Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient

  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

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.

Summary

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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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Northwestern University at Feinberg School of Medicine, Chicago, IL, USA

    Sarah Chuzi

  2. Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Esther S. Pak

  3. Center for Advanced Heart Disease, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Akshay S. Desai & Haider J. Warraich

  4. Harvard Medical School, Boston, MA, USA

    Akshay S. Desai, Kristen G. Schaefer & Haider J. Warraich

  5. Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA

    Kristen G. Schaefer

  6. Division of Palliative Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Kristen G. Schaefer

  7. Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, MA, USA

    Haider J. Warraich

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  1. Sarah Chuzi
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  2. Esther S. Pak
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  3. Akshay S. Desai
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  5. Haider J. Warraich
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Correspondence to Haider J. Warraich.

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Dr. Desai reports personal fees from Abbott, grants and personal fees from Alnylam, grants and personal fees from AstraZeneca, personal fees from Boston Scientific, personal fees from Boehringer Ingelheim, grants and personal fees from Biofourmis, personal fees from DalCor Pharma, grants and personal fees from Novartis, personal fees from Relypsa, and personal fees from Regeneron, outside the submitted work.

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Chuzi, S., Pak, E.S., Desai, A.S. et al. Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient. Curr Heart Fail Rep 16, 220–228 (2019). https://doi.org/10.1007/s11897-019-00440-3

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