The Present and Future
Review Topic of the Week
Palliative Care in Heart Failure: Rationale, Evidence, and Future Priorities

https://doi.org/10.1016/j.jacc.2017.08.036Get rights and content
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Abstract

Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.

Key Words

heart failure
hospice
palliative care
quality of care
quality of life

Abbreviations and Acronyms

CI
confidence interval
DT
destination therapy
HF
heart failure
QoL
quality of life
RCT
randomized clinical trial
VAD
ventricular assist device

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The contents of this article do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. Dr. Kavalieratos receives research support from the National Heart, Lung, and Blood Institute (grant K01-HL133466). Dr. Gelfman was supported by a K23 grant from the National Institute on Aging (K23-AG049930). Dr. Bekelman receives research support from the Department of Veterans Affairs and the Veterans Affairs Eastern Colorado Health Care System. Dr. Goldstein is supported by funds from the Mount Sinai Claude D. Pepper Older Americans Independence Center (grant P30-AG028741) and a grant from the National Heart, Lung, and Blood Institute (R01-HL102084). Dr. Bakitas is supported by a grant from the National Institute of Nursing Research (R01-NR013665). IMPACT-HF2 (Improve Palliative Care Therapies for Patients with Heart Failure and Their Families), a working group of palliative care and heart failure experts, was supported by the American Federation for Aging Research, the John A. Hartford Foundation, the National Palliative Care Research Center, Mount Sinai’s Claude Pepper Older American Independence Center (grant P30-AG028741), and University of Alabama at Birmingham Centers for Comprehensive Cardiovascular Care and Palliative and Supportive Care. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Michele A. Hamilton, MD, served as Guest Editor for this paper.

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