title: Primary palliative care for heart failure: what is it? How do we implement it?
abstract: Heart failure (HF) is a chronic and progressive illness, which affects a growing number of adults, and is associated with a high morbidity and mortality, as well as significant physical and psychological symptom burden on both patients with HF and their families. Palliative care is the multidisciplinary specialty focused on optimizing quality of life and reducing suffering for patients and families facing serious illness, regardless of prognosis. Palliative care can be delivered as (1) specialist palliative care in which a palliative care specialist with subspecialty palliative care training consults or co-manages patients to address palliative needs alongside clinicians who manage the underlying illness or (2) as primary palliative care in which the primary clinician (such as the internist, cardiologist, cardiology nurse, or HF specialist) caring for the patient with HF provides the essential palliative domains. In this paper, we describe the key domains of primary palliative care for patients with HF and offer some specific ways in which primary palliative care and specialist palliative care can be offered in this population. Although there is little research on HF primary palliative care, primary palliative care in HF offers a key opportunity to ensure that this population receives high-quality palliative care in spite of the growing numbers of patients with HF as well as the limited number of specialist palliative care providers.
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA. Laura.Gelfman@mssm.edu.|Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA. Laura.Gelfman@mssm.edu.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Gelfman
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Winifred G
authors.initials: WG
authors.lastname: Teuteberg
authors.affiliation: Divisions of Cardiology and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Lala
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA.|Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Goldstein
mesh_terms: D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D011320:Primary Health Care; D011379:Prognosis; D011788:Quality of Life
keywords: Heart failure; Palliative care