title: Palliative care in patients with heart failure.
abstract: Despite advances in cardiac therapy, heart failure (HF) remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, and healthcare systems. Palliative care is a multidisciplinary approach to care that focuses on communication, shared decision making, and advance care planning; provides relief from pain and other distressing symptoms; integrates psychological and spiritual aspects of care; and offers a support system to help families cope during illness and bereavement. Palliative care has applications across the stages of heart failure, including early in the course of illness, often in conjunction with other therapies that are intended to prolong life. However, the incorporation of palliative care into the management of heart failure has been suboptimal for several reasons: uncertainty in the disease trajectory, failure to reward communication between healthcare providers and patients, siloed care, lack of knowledge, overlay of comorbidity and frailty, life saving devices with complex trade-offs, and a limited evidence base. This review will summarize the current literature on the emerging role of palliative care in patients with heart failure and the challenges and opportunities for its integration into routine care. It will discuss current initiatives and future directions of the collaborative relationship between the palliative care and heart failure disciplines.
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA Adult and Child Center for Health Outcomes and Research and Delivery Sciences, University of Colorado School of Medicine, Aurora, CO, USA Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: McIlvennan
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA Adult and Child Center for Health Outcomes and Research and Delivery Sciences, University of Colorado School of Medicine, Aurora, CO, USA Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA larry.allen@ucdenver.edu.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
mesh_terms: D000223:Adaptation, Psychological; D032722:Advance Care Planning; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable; D018450:Disease Progression; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D059408:Pain Management; D010166:Palliative Care / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011788:Quality of Life; D014342:Truth Disclosure; D035501:Uncertainty; D028761:Withholding Treatment