Multimorbidity and End of Life Care in Patients with Cardiovascular Disease.
The care of patients with severe cardiovascular disease and multimorbidity entails complex medical decision-making especially at the end of life. Proven therapies must be incorporated into the context of patient preferences, values, and goals to achieve effective titration of medications and appropriate initiation and withdrawal of cardiac device therapies. As patients decline in the terminal stages, it is important to modify medical and device therapies in accordance with goals and values, and with hemodynamic changes, increasing multimorbidity, and accumulating symptom burden. The provision of effective end of life care for those with cardiovascular disease and multimorbidity requires cooperation between palliative care, specialty care, and primary care.
Palliative Care, Hospital of the University of Pennsylvania, Ravdin 2, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Esther
E
Pak
Cardiology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, East Pavilion, 2nd Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Joyce
J
Wald
Cardiology, Bioethics and Humanities, Regional Heart Center, University of Washington Medical Center, 1959 Pacific Avenue Northeast, Seattle, WA 98125, USA. Electronic address: kirkpatj@cardiology.washington.edu.
James N
JN
Kirkpatrick
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D000066491:Clinical Decision-Making; D015897:Comorbidity; D006801:Humans; D000069342:Medical Overuse / Q000517:prevention & control; D000070659:Patient Comfort / Q000379:methods; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000523:psychology
Decision-making; End of life; Withdrawal of cardiac devices