Quarterly Focus Issue: Heart Failure
State-of-the-Art Paper
Palliative Care in Congestive Heart Failure

https://doi.org/10.1016/j.jacc.2009.02.078Get rights and content
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Symptoms and compromised quality of life prevail throughout the course of heart failure (HF) and thus should be specifically addressed with palliative measures. Palliative care for HF should be integrated into comprehensive HF care, just as evidence-based HF care should be included in end-of-life care for HF patients. The neurohormonal and catabolic derangements in HF are at the base of HF symptoms. A complex set of abnormalities can be addressed with a variety of interventions, including evidence-based HF care, specific exercise, opioids, treatment of sleep-disordered breathing, and interventions to address patient and family perceptions of control over their illness. Both potential sudden cardiac death and generally shortened length of life by HF should be acknowledged and planned for. Strategies to negotiate communication about prognosis with HF patients and their families can be integrated into care. Additional evidence is needed to direct care at the end of life, including use of HF medications, and to define management of multiple sources of distress for HF patients and their families.

Key Words

end of life
palliative care
symptom management
heart failure

Abbreviations and Acronyms

CPAP
continuous positive airway pressure
ESAS
Edmonton Symptom Assessment System
HF
heart failure
HFnEF
heart failure with normal ejection fraction
LVSD
left ventricular systolic dysfunction
NYHA
New York Heart Association
SCD
sudden cardiac death
SSRI
selective serotonin reuptake inhibitor

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Dr. Goodlin has received research grants from Boston Scientific and St. Jude Medical Foundation.