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QUARTERLY FOCUS ISSUE: HEART FAILURE: STATE-OF-THE-ART PAPER

Palliative Care in Congestive Heart Failure

Patient-Centered Education and Research, Salt Lake City, Utah

Manuscript received October 5, 2008; revised manuscript received February 6, 2009, accepted February 9, 2009.

^_* Reprint requests and correspondence: Dr. Sarah J. Goodlin, Patient-Centered Education and Research, 681 East 17th Avenue, Salt Lake City, Utah 84103 (Email: sjg-pcer{at}comcast.net).

Symptoms and compromised quality of life prevail throughout the course of heart failure (HF) and thus should be specifically addressed with palliative measures. Palliative care for HF should be integrated into comprehensive HF care, just as evidence-based HF care should be included in end-of-life care for HF patients. The neurohormonal and catabolic derangements in HF are at the base of HF symptoms. A complex set of abnormalities can be addressed with a variety of interventions, including evidence-based HF care, specific exercise, opioids, treatment of sleep-disordered breathing, and interventions to address patient and family perceptions of control over their illness. Both potential sudden cardiac death and generally shortened length of life by HF should be acknowledged and planned for. Strategies to negotiate communication about prognosis with HF patients and their families can be integrated into care. Additional evidence is needed to direct care at the end of life, including use of HF medications, and to define management of multiple sources of distress for HF patients and their families.

Key Words: end of life • palliative care • symptom management • heart failure

Abbreviations and Acronyms   CPAP = continuous positive airway pressure   ESAS = Edmonton Symptom Assessment System   HF = heart failure   HFnEF = heart failure with normal ejection fraction   LVSD = left ventricular systolic dysfunction   NYHA = New York Heart Association   SCD = sudden cardiac death   SSRI = selective serotonin reuptake inhibitor

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