Speaking Up: The Need for Palliative Care Earlier in HF Treatment

When it comes to the treatment of heart failure (HF) patients, Larry A. Allen, MD, believes that there is a big white elephant in the room that no one is talking about: palliative care.

The prognosis of HF is similar to that of most types of cancer; however, while palliative care is widely accepted and discussed as part of the treatment of cancer patients, the subject is largely ignored in discussions about HF management.

“We know that heart failure is associated with high rates of morbidity and mortality and that survival is limited, yet providers are not confronting end-of-life issues,” said Allen, assistant professor at the University of Colorado, in a presentation delivered Wednesday at the HFSA 14th Annual Scientific Session entitled, “End-of-Life: Transitioning to Palliative Care.”

“It’s very difficult for patients with a heart failure diagnosis to recognize the mortality they face in coming years,” noted Allen, citing a study in which HF patients exhibited worse symptoms, greater depression and worse spiritual well-being than patients with cancer. It is the clinician’s job, he said, to speak candidly with patients and their family members about the prognosis, and to discuss the patient’s priorities and wishes.

For most patients, he noted, it is important that dying is not prolonged, that they have control over decision-making, that pain and symptoms are controlled, and that they do not become a burden to family members. Research, however, has shown that although 90% of patients say that they wish to die at home, nearly 50% die in the hospital. “We aren’t doing a good job of respecting what people want,” said Allen. “We can do a better job.”

Another key issue, he noted, is the fact that many patients confuse palliative care with hospice care, which is limited to patients with a terminal diagnosis of less than six months. Palliative care, he said, focuses on pain and symptom management, and can benefit patients who are still seeking aggressive treatment. “It doesn’t mean that curative care has stopped,” he said.

Allen urged cardiologists and other healthcare professionals who treat HF patients to initiate conversations about palliative care early on with patients and their families.

“This needs to start happening in the ambulatory setting,” he said. “We have to move palliative care upstream.”