title: End-of-life care in patients with heart failure.
abstract: Stage D heart failure (HF) is associated with poor prognosis, yet little consensus exists on the care of patients with HF approaching the end of life. Treatment options for end-stage HF range from continuation of guideline-directed medical therapy to device interventions and cardiac transplantation. However, patients approaching the end of life may elect to forego therapies or procedures perceived as burdensome, or to deactivate devices that were implanted earlier in the disease course. Although discussing end-of-life issues such as advance directives, palliative care, or hospice can be difficult, such conversations are critical to understanding patient and family expectations and to developing mutually agreed-on goals of care. Because patients with HF are at risk for rapid clinical deterioration or sudden cardiac death, end-of-life issues should be discussed early in the course of management. As patients progress to advanced HF, the need for such discussions increases, especially among patients who have declined, failed, or been deemed to be ineligible for advanced HF therapies. Communication to define goals of care for the individual patient and then to design therapy concordant with these goals is fundamental to patient-centered care. The objectives of this white paper are to highlight key end-of-life considerations in patients with HF, to provide direction for clinicians on strategies for addressing end-of-life issues and providing optimal patient care, and to draw attention to the need for more research focusing on end-of-life care for the HF population.
authors.affiliation: Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania. Electronic address: djw150@jefferson.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Division of General Internal Medicine and Geriatrics, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, Oregon.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Goodlin
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Dickinson
authors.affiliation: Center for Health Policy, Center for Primary Care and Outcomes Research, Veterans Affairs Palo Alto Medical Center, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Connie
authors.initials: C
authors.lastname: Jaenicke
authors.affiliation: Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina.
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017051:Hospice Care / Q000379:methods; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013727:Terminal Care / Q000379:methods*
keywords: Advanced heart failure; end-of-life care; hospice; palliative care