Health care providers can improve quality of life and reduce symptom burden for heart failure patients by integrating palliative principles and referring to specialists as needed.
Heart failure is an increasingly common condition among the aging U.S. population. These patients often experience severe symptoms that can include shortness of breath, coughing, nausea, fatigue, pain and depression and anxiety, among others, according to the American Heart Association (AHA). This population also tends to see high rates of hospitalizations.
Given these factors, many of these patients should be receiving some form of palliative care, Dr. Larry Allen, chief of cardiology at the University of Colorado, said in a recent AHA webinar. Allen is also chair of the AHA’s Clinical Cardiology Council.
“Heart failure is associated with significant mortality, high symptom burden, poor functional status and quality of life, frequent hospitalizations, and mortality in our patients that is relatively high,” Allen said during the webinar. “While guideline-directed heart failure therapies can improve survival, reduce symptoms like shortness of breath, swelling and improve quality of life. People living with heart failure continue to have unmet care needs and face uncertainty about their prognosis. And palliative care can help.”
Palliative care can help in a variety of ways. In addition to symptom management, the integration of palliative care into heart failure treatments can help identify patients’ goals of care and establish advance care plans, as well as address their psychosocial needs and social determinants of health and offer support for the family, Allen indicated.
The need for this care is growing. Cardiovascular disease is the leading cause of death among adults in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). Approximately 6.7 million U.S. adults suffer from heart failure, a number expected to rise to 8.5 billion by 2030, a 2023 study in the Journal of Cardiac Failure found.
Hospitalization rates have also been rising, according to the study. Hospitalizations due to heart failure reached nearly 1.3 million in 2018, up from slightly less than 1.1 million in 2008. Readmission rates saw similar trends.
By 2030, the direct medical costs associated with heart failure are expected to reach $53 billion, with indirect costs exceeding $70 billion.
Current clinical practice guidelines for heart failure also call for palliative support, including those from the AHA, the Heart Failure Society of America and the American College of Cardiology. However, providers must distinguish between “primary palliative care,” where palliation is incorporated into routine services, and “secondary palliative care” that involves specialty teams.
“Primary palliative care is what we all do. It’s basic knowledge and skills for all health care professionals to think about how we alleviate suffering, help patients think about what end of life and death looks like, treating basic symptoms, including depression and anxiety, in shortness of breath,” Allen said. “Specialist palliative care are clinicians who’ve actually done a fellowship with specialized training and experience in the care of seriously ill and dying patients. So this is a team approach. We’re starting with primary palliative care, and then when things get really complicated, we call a palliative care specialist to help us out.”
