Not for the Faint of Heart: Caring for Patients with Advanced Heart Failure (P18)

Abstract

•Describe the heart failure disease trajectory and the role of palliative and hospice care from diagnosis to death.•Discuss the types, stages, and classes of heart failure and the clinical characteristics of each.•Identify three clinical issues common in advanced heart failure as the end of life approaches, with shared decision-making considerations relevant to the medical testing and treatments for each.•Identify four symptoms common in advanced heart failure patients, with appropriate palliative care and hospice intervention approaches for each.•Explain the role of cardiac devices (ICD, pacemaker, CRT device and VAD) in advanced heart failure and advance care planning strategies appropriate to each.•Outline hospice eligibility criteria for patients with advanced heart failure, and three keys to effectively implementing guideline-based hospice heart failure care. Today, people are living longer with heart disease while its prevalence is increasing. Historical trends that have limited the integration of palliative care in cardiology and HF care are shifting. Over the last 10 years, there has been growing evidence to support palliative care interventions for HF patients and their families, as well as integrating interdisciplinary HF, palliative care, and hospice. Patients with HF require complex pharmacological and self-care regimens to control symptoms and prevent recurrent hospitalizations. Coexisting conditions add to the complexity of self-care for the patient and family and necessitate individualized approaches to assessment and intervention strategies. Guideline-directed medications (GDMs) are pharmacological therapies for HF patients that have strong evidence to achieve positive outcomes, including symptom management and quality of life. Both the ACCF/AHA guidelines and the NCP Clinical Practice Guidelines define and emphasize the value of palliative care and aim to improve the delivery of palliative care to this seriously ill population. Using a case study approach, this session will provide the current state of the science and treatment for heart failure. This includes a review of heart failure types, its trajectory, assessment, complications and guideline-based treatments, the role of cardiac devices and shared decision-making. Guideline-based care delivery will be emphasized across all settings, from acute care to outpatient care, to transitional care to hospice. Support and symptom management will emphasize holistic approaches to promote quality of life and positive outcomes throughout the lives and deaths of patients and families coping with this complex and challenging diagnosis.