title: Dilemmas in end-stage heart failure.
abstract: Heart failure (HF), a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S. National Library of Medicine website (www.pubmed.gov) using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF (worse than that for many cancers), many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society.
authors: Veterans Affairs Healthcare System Ann Arbor, 2215 Fuller Rd., Ann Arbor, MI 48105, USA.
authors: Carol
authors: C
authors: Chen-Scarabelli
authors: St. John Hospital and Medical Center/Wayne State University, 22101 Moross Rd., Detroit, MI 48236, USA.
authors: Louis
authors: L
authors: Saravolatz
authors: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.
authors: Benjamin
authors: B
authors: Hirsh
authors: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.
authors: Pratik
authors: P
authors: Agrawal
authors: St. John Hospital and Medical Center/Wayne State University, 22101 Moross Rd., Detroit, MI 48236, USA ; Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.
authors: Tiziano M
authors: TM
authors: Scarabelli
keywords: Ethical dilemmas; Heart failure; Palliative care