title: Philosophical implications of the systemic and patient-oriented management of chronic heart failure.
abstract: Chronic heart failure is a lifelong disease that involves a large variety of symptoms and, ultimately, the entire organism relatively early in the disease process. At least in part, this is in contrast to other chronic conditions such as diabetes, renal failure or cancer. Modern treatment of patients with chronic heart failure goes beyond the mere prescription of vasodilators or inotropes. The multitude of multi-organ involvements and associated symptoms unrelated to pure cardiac contractile failure, as well as the psychosocial burden for patients and their direct environment, calls for a re-engagement with the philosophical aspects of medical care. Such a process may well challenge the approach commonly taken by health care providers. We further suggest a broader and more holistic view of medical care--in this case in regard to heart failure--and one that is based on patients' and physicians' understanding of health and disease, autonomy, suffering, existential values and expectations that might positively affect treatment strategies and outcomes.
authors.affiliation: Cedars Sinai Heart Institute, Division of Cardiology, Cedar Sinai Medical Center, 8700 Beverly Blvd, Suite 6215, Los Angeles, CA 90048, USA. Ernst.Schwarz@cshs.org
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
authors.forename: Laurent
authors.initials: L
authors.lastname: Cleenewerck
authors.forename: Anita
authors.initials: A
authors.lastname: Phan
authors.forename: Parag
authors.initials: P
authors.lastname: Bharadwaj
authors.forename: Russell
authors.initials: R
authors.lastname: Hobbs
mesh_terms: D002908:Chronic Disease; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008962:Models, Theoretical; D018802:Patient-Centered Care / Q000458:organization & administration*; D010686:Philosophy, Medical; D012648:Self Care