Primary palliative care for heart failure: what is it? How do we implement it?
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Heart failure (HF) is a chronic and progressive illness, which affects a growing number of adults, and is associated with a high morbidity and mortality, as well as significant physical and psychological symptom burden on both patients with HF and their families. Palliative care is the multidisciplinary specialty focused on optimizing quality of life and reducing suffering for patients and families facing serious illness, regardless of prognosis. Palliative care can be delivered as (1) specialist palliative care in which a palliative care specialist with subspecialty palliative care training consults or co-manages patients to address palliative needs alongside clinicians who manage the underlying illness or (2) as primary palliative care in which the primary clinician (such as the internist, cardiologist, cardiology nurse, or HF specialist) caring for the patient with HF provides the essential palliative domains. In this paper, we describe the key domains of primary palliative care for patients with HF and offer some specific ways in which primary palliative care and specialist palliative care can be offered in this population. Although there is little research on HF primary palliative care, primary palliative care in HF offers a key opportunity to ensure that this population receives high-quality palliative care in spite of the growing numbers of patients with HF as well as the limited number of specialist palliative care providers.
KeywordsHeart failure Palliative care
Compliance with ethical standards
Dr. Gelfman receives support from the National Institute on Aging (NIA) (1K23AG049930), the Mount Sinai Older Adults Independence Center (P30AG028741), the American Federation on Aging Research, and the National Palliative Care Research Center. Dr. Kavalieratos receives research support from the National Heart, Lung, and Blood Institute (K01HL13346), the Cystic Fibrosis Foundation, as well as a Junior Faculty Career Development Award from the National Palliative Care Research Center. Dr. Teueteberg receives support from the Cystic Fibrosis Foundation. Dr. Goldstein receives support from The Mount Sinai Older Adults Independence Center (P30AG028741).
The manuscript does not contain clinical studies or patient data. This article does not contain any studies with human participants or animals performed by any of the authors.
Conflict of interest
The authors declare that they have no conflict of interest.
- 12.Hunt SA, Abraham WT, Chin MH et al (2009) Focused update incorporated into the ACC/AHA 2005 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 119(14):e391–e479CrossRefPubMedGoogle Scholar
- 15.Steinhauser KE, Arnold RM, Olsen MK et al (2011) Comparing three life-limiting diseases: does diagnosis matter or is sick, sick? J Pain Symptom ManageGoogle Scholar
- 28.Abernethy AP, Currow DC, Fazekas BS, Luszcz MA, Wheeler JL, Kuchibhatla M (2008) Specialized palliative care services are associated with improved short- and long-term caregiver outcomes. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 16(6):585–597CrossRefGoogle Scholar
- 32.Wong F, Ng A, Lee P, et al (2016) Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial. HeartGoogle Scholar
- 36.Braun LT, Grady KL, Kutner JS et al (2016) Palliative care and cardiovascular disease and stroke: a policy statement from the American Heart Association/American Stroke Association. CirculationGoogle Scholar
- 39.Fang JC, Ewald GA, Allen LA et al (2015) Advanced (stage D) heart failure: a statement from the heart failure society of america guidelines committee. J Card FailGoogle Scholar
- 40.Yancy CW, Jessup M, Bozkurt B et al 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice fuidelines. CirculationGoogle Scholar
- 42.Dans M, Garcia K (2015) Palliative care and hospice in patients with advanced cardiovascular disease. End-of-Life Care in Cardiovascular Disease: Springer:33–49Google Scholar
- 43.Jurgens CY, Goodlin S, Dolansky M et al (2015) Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation: Heart Failure 8(3):655–687Google Scholar
- 45.Andersen J (2009) NHPCO 2009 facts and figures. 1–15Google Scholar
- 49.Kavalieratos D (2014) Attitudes and perceptions regarding a generalist plus specialist model of palliative care in heart failure. J Am Coll Cardiol 63(12_S)Google Scholar
- 50.Kavalieratos D, Mitchell EM, Carey TS et al (2014) “Not the ‘grim reaper service’”: an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure. J Amer Heart Assn 3(1):e544–e544Google Scholar
- 51.Kamal AH, Maguire JM, Meier DE (2015) Evolving the palliative care workforce to provide responsive, serious illness care. Ann Intern MedGoogle Scholar
- 52.A Call to Action: Policy Initiatives to Support Palliative Care. https://reportcard.capc.org/recommendations/. Accessed 5/12, 2016
- 54.Schenker Y, Arnold R (2015) The next era of palliative care. JAMA:1–2Google Scholar
- 70.Sherman DW, Matzo ML, Rogers S, McLaughlin M, Virani R (2002) Achieving quality care at the end of life: a focus of the End-of-Life Nursing Education Consortium (ELNEC) curriculum. Journal of professional nursing : official journal of the American Association of Colleges of Nursing 18(5):255–262CrossRefGoogle Scholar
- 71.Sherman DW, Matzo ML, Pitorak E, Ferrell BR, Malloy P (2005) Preparation and care at the time of death: content of the ELNEC curriculum and teaching strategies. Journal for nurses in staff development : JNSD : official journal of the National Nursing Staff Development Organization 21(3):93–100 quiz 101-102CrossRefGoogle Scholar
- 74.2016 Health NIo. integrating palliative care with disease management to improve outcomes among patients with advanced heart failure: interventional research career development. https://projectreporter.nih.gov/project_info_description.cfm?aid=9162916&icde=31188392&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC. Accessed September 28, 2016
- 75.Berlacher K TW, Reitschuler-Cross E, Arnold RM (2015) CardioTalk: the future of communication training in cardiovascular medicine. Paper presented at: American College of Cardiology Annual Assembly; San Diego, CAGoogle Scholar
- 81.Stevenson LW, Davis RB (2016) Model building as an educational hobby. Circ Heart Fail 9(8)Google Scholar
- 82.Xie K, Gelfman L, Horton JR, Goldstein NE (2017) State of research on palliative care in heart failure as evidenced by published literature, conference proceedings, and NIH Funding. J Card Fail 23(2):197–200Google Scholar