Palliative care and heart failure: is it time to talk?

Abstract

Heart failure (HF) is one of the leading causes of hospitalization in high-income countries and has a profound negative impact on quality of life. In the United States there are more than 900,000 new cases per year and over one million hospital admissions with a primary diagnosis of HF. A prevalence of 6,500,000 cases (2.2% of the population of aged >20 years) was estimated for the US in 2014, in which there were 300,000 related deaths. Although survival has increased, thanks to the pharmacological and non pharmacological therapy, roughly 50% of HF patients die within 5 years of being diagnosed. HF is a chronic, progressive and incurable syndrome characterized by alternating periods of apparent stability and acute exacerbations, with frequent hospitalizations. Patients with HF experience a high level of symptoms and symptom burden over time, particularly at the end of life. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, thirst, fatigue and psychological distress. In HF patients the symptom burden is similar to cancer patients, but patients with advanced HF, in comparison to advanced cancer patients, have a greater number of physical symptoms, worse depression status and lower spiritual well-being. There is evidence that HF patients have the same palliative needs as cancer patients, roughly in 40% of cases, but only 20% actually are admitted to hospice programs in US. This situation seems to be the consequence of cultural gap between guidelines, addressing palliative care and HF, and clinical practice. Bridging this gap is a priority to implement an holistic approach to advanced HF.