Heart Failure Care Moving to Palliative Approach

Cardiac experts and public policy makers have growing concerns about heart failure, which is increasing in prevalence and costing billions of dollars a year.

Palliative care has traditionally played only a limited role in treating patients with heart failure, but at the suggestion of the American College of Cardiology Foundation and American Heart Association, its role has been on the rise.

In addition, the US Centers for Medicare and Medicaid Services (CMS) and the Joint Commission now require ventricular assist device (VAD) care teams to include a palliative care expert.

The journal Heart Failure Clinics has published an overview of palliative care in the treatment of heart failure in the United States in its October issue.

The study authors detailed that patients with heart failure have only 2 life-prolonging options: cardiac transplantation and VAD. Few patients are actually eligible for these options, though.

Cardiac transplantation comes with lifelong immunosuppression, risk of graft failure or rejection, infection, and malignancy. Meanwhile, VAD presents risks of infection, bleeding, and device malfunctioning.

Depression is a common comorbidity deserving of attention due to its ability to decrease quality of life.

More than half of health care spending for heart failure patients’ final 2 years of life occurs in the last 6 months. The average patient spends 25% of that time in the hospital.

However, research indicates that fewer patients with heart failure are dying in the hospital, which is costly and unnecessary, since 2003. The current rate is approximately 22%, down from 33%.

Hospice utilization and palliative care consultations increased over this same period. One area that needs improvement is hospice employee understanding of end-stage heart failure, an area where pharmacists can be quite helpful.

Experts strongly suggest that clinicians take a palliative care approach and discontinue medications that may worsen comorbidities or provide time-dependent patient benefit, including guideline-directed medical therapy that is preventive in nature.

The latest guidelines encourage (presently underutilized) palliative care as the American health care system increasingly moves away from a curative approach.