End-of-life options for patients with advanced heart failure.
Heart failure is a progressive disease with significant morbidity and mortality, but prognostication often is difficult. Many of the evidence-based therapies for heart failure provide symptomatic benefit, but may have intolerable side effects for patients with advanced disease. At the end of life, there is evidence of varying strengths for pharmacologic and nonpharmacologic relief of common symptoms like dyspnea, fatigue, pain, and depression. Patients also may benefit from inotropic therapy, ventricular assist devices, and hospice care. It is important for physicians to encourage patients to formulate advance directives, including decisions about do not resuscitate orders and deactivation of implantable cardioverter-defibrillators and ventricular assist devices.
Goldfinger
Judith Z
JZ
Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1118, New York, NY 10029, USA.
Adler
Eric D
ED
D002316:Cardiotonic Agents / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006353:Heart-Assist Devices; D017051:Hospice Care; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D016414:Resuscitation Orders; D013727:Terminal Care / Q000379:methods*
D002316:Cardiotonic Agents