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Primary palliative care for heart failure: what is it? How do we implement it?

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Abstract

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.

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Authors and Affiliations

  1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA

    Laura P. Gelfman & Nathan E. Goldstein

  2. Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA

    Laura P. Gelfman & Nathan E. Goldstein

  3. Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Dio Kavalieratos & Winifred G. Teuteberg

  4. Divisions of Cardiology and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anuradha Lala

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  1. Laura P. Gelfman
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  2. Dio Kavalieratos
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  3. Winifred G. Teuteberg
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  4. Anuradha Lala
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  5. Nathan E. Goldstein
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Correspondence to Laura P. Gelfman.

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Funding sources

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).

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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.

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The authors declare that they have no conflict of interest.

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Gelfman, L.P., Kavalieratos, D., Teuteberg, W.G. et al. Primary palliative care for heart failure: what is it? How do we implement it?. Heart Fail Rev 22, 611–620 (2017). https://doi.org/10.1007/s10741-017-9604-9

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