The challenge of palliative care in heart failure

Abstract

The integration of palliation within non-malignant chronic disease is a particularly challenging yet important consideration in the management of terminal patients. Patients dying from life limiting chronic diseases, particularly within acute care settings, are susceptible to inadequate end-of-life care. Good palliation could improve communication, symptom management and quality of life. In heart failure, however, this service remains underused and poorly integrated, with only a small number of patients with non-malignant diseases receiving palliative care despite the strong evidence that supports it (National Council for Palliative Care, 2010 ; LeMond and Allen, 2011 ). Mortality risk is high in heart failure, and with the prevalence and incidence of heart failure set to rise within the ageing population, it has become a healthcare and nursing priority to address issues of equity in palliative care delivery ( National Institute of Health and Clinical Excellence [NICE], 2010 ). There are multidimensional barriers to palliative care within the cardiology setting and the development strategies will require an integrated approach. Key challenges that need addressing from a health professional perspective include health professionals’ knowledge of palliative care, poor recognition of end-stage heart failure by health professionals and, and health professionals’ lack of communication about prognosis with patients.