Palliative Care in the Treatment of Advanced Heart Failure

Abstract

Heart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure).1 Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. In recognition of this, palliative/hospice care referral was recommended for end-stage heart failure (Level of Evidence 1A) in the most recent American College of Cardiology/American Heart Association heart failure guidelines.2 To identify evidence-based studies of palliative care in heart failure, we searched the Medline database for literature with the medical subject headings “heart failure” and “palliative care,” “supportive care,” or “symptom management” and found 394 results. We identified 92 systematic reviews, 44 of which were English-language systematic reviews published within the past 5 years. More than 5 million Americans have heart failure, with a yearly incidence estimated to be >500 000.3 The number of deaths due to heart failure in 2004 was 284 365, which exceeds the deaths due to lung cancer, breast cancer, prostate cancer, and HIV/AIDS combined (Table 1).3–5 Even as the national death rate decreased by 2% from 1994 to 2004, deaths due to heart failure increased by 28%. View this table: Table 1. Incidence of and Number of Deaths Due to Heart Failure Compared With Other Common Causes of Death in the United States The yearly cost of heart failure was roughly $30 billion in 2006.6 The mean hospital length of stay is almost 6 days, and more than one third of patients are admitted for more than 5 days. Nearly half of the hospitalizations for heart failure exceed Medicare diagnosis-related groups reimbursement.7 Compared with all other patients, …