Palliative Care in Heart Failure

Abstract

Heart failure is a life limiting cardiovascular condition, frequently encountered in the increasingly aged population. People affected endure a symptomatic burden and mortality risk at least equivalent to those associated with common cancers. However, the clinical scenario is usually more complicated in that heart failure tends to occur in multimorbid older individuals who exhibit an unpredictable disease trajectory. In most patients, cardiac function tends to decline inexorably, with a mortality of about 50% in the 5 years following diagnosis. An ever more complex evidence-based therapy, which likely materially benefits less than half of those with this clinical diagnosis, involves polypharmacy, implanted cardiac devices, and consideration for surgical intervention including cardiac transplantation. Acknowledging its prognostic ambiguity, the capricious nature of the heart failure state, and the relatively onerous treatment protocol may undermine care coordination, patient autonomy, and ultimately conflict with patients’ and families’ preferences for care along a progressively declining clinical course to the end of life. This chapter describes the challenges and opportunities in providing palliative care to this burgeoning clinical population.