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End of Life Discussions - Finding the Words - Dosing and Drugs

  • Published: 2011-09-20 (Revised/Updated 2016-06-11) : Author: The Heart Failure Society of America
  • Synopsis: Palliative care for advanced heart failure patients and reevaluate when a physician should discuss a patients goals to determine treatment.

Main Document

"Heart failure is a progressive condition in which the heart muscle becomes weakened after it is injured, most commonly from heart attack or high blood pressure, and gradually loses its ability to pump enough blood to supply the body's needs."

Tools for End-of-Life Discussion: Finding the Words, Dosing the Drugs - Selecting treatments based on heart failure patient's goals.

The 15th Annual Scientific Meeting of the Heart Failure Society of America (HFSA) will include a session on the growing relationship between palliative care and cardiology, "Tools for End-of-Life Discussion: Finding the Words, Dosing the Drugs." Contributors Dr. Nathan Goldstein and Dr. Kristin G. Schaefer will focus on palliative care for advanced heart failure patients and reevaluate when a physician should discuss a patient's goals to determine treatment.

"We work with patients so they know what to expect allowing them to make informed decisions on future treatments," said Dr. Schaefer, MD, Director of Resident Education in the Department of Psychosocial Medicine and Palliative Care at the Dana Farber Cancer Institute and Brigham and Women's Hospital. "We promote shared decision-making; when it comes to an end-of-life discussion, the patient's perspective is most important."

Dr. Schaefer will discuss Stage D heart failure patients and will provide additional insight into the growing relationship between cardiology and palliative care.

Her research focuses on predictable points along a heart failure patient's path and the conversations a physician needs to have with a patient to provide a strong therapeutic alliance. Dr. Schaefer will introduce studies that prove shared-decision making and an increase in palliative care for heart failure patients can not only increase patient satisfaction, but can also give physicians a sense of meaning and enjoyment in their work.

"In addition to reevaluating how we conduct these end-of-life discussions, we need to adjust the time-frame of when we have these discussions with patients," said Dr. Goldstein, MD, Associate Professor of Medicine, Geriatrics and Palliative Medicine at Mount Sinai Medical Center. "Conversations about a patient's expectations and goals shouldn't happen at the point of end-of-life, they need to happen right when the patient is diagnosed with late stage heart failure. There are better ways to ask what the patient wants and from there decide what treatments work with his or her goals. Although both patients and physicians may try to avoid these issues, they need to recognize the truth that "difficult discussions now will simplify difficult decisions in the future."

Dr. Goldstein will also address the "how" and the "when" of palliative care discussions.

He will argue that doctors should have these conversations earlier in patients' diseases when their conditions are more stable. Goldstein also asserts that the "how" should focus on the language doctors use. Asking patients "what's important to you right now" is more effective than "do you want to be put on a life-support machine"

For a complete list of annual meeting sessions or for details on attending the conference, call (617) 226-7183 or visit and click on Annual Scientific Meeting .

There is no registration fee for accredited journalists. Interview areas will be available on-site in addition to a fully-staffed press room with phone and internet accessibility. You may follow news from the meeting on Twitter #HFSA.

About Heart Failure

Heart failure is a progressive condition in which the heart muscle becomes weakened after it is injured, most commonly from heart attack or high blood pressure, and gradually loses its ability to pump enough blood to supply the body's needs. Many people are not aware they have heart failure because the symptoms are often mistaken for signs of getting older. Heart failure affects 4.6 to 4.8 million individuals in the United States. Demographic and clinical evidence strongly suggests that the prevalence of heart failure will increase throughout the next decade. Ten to 15 years ago heart failure was considered a "death sentence;" however, recent advances in treatment have shown that early diagnosis and proper care in early stages of the condition are key to slowing, stopping or in some cases reversing progression, improving quality of life, and extending life expectancy. For more information on heart failure, please visit

About the Heart Failure Society of America

The Heart Failure Society of America (HFSA) is a nonprofit educational organization, founded in 1994 as the first organized association of heart failure experts. The HFSA provides a forum for all those interested in heart function, heart failure research and patient care. The Society also serves as a resource for governmental agencies (FDA, NIH, NHLBI, CMS). The HFSA Annual Scientific Meeting is designed to highlight recent advances in the development of strategies to address the complex epidemiological, clinical and therapeutic issues of heart failure. Additional information on HFSA can be found at

Similar Topics

1 : Palliative Care Findings on Caregiver Depression, LGBT Partners, Moral Distress : Loyola University Health System.
2 : Defining the Changing Nature of Wisdom at the End of Life : University of California - San Diego.
3 : Blood Pressure Begins to Decline 14-18 Yrs Before Death : University of Connecticut.
4 : How Do Doctors Make Decisions When Managing Care for Critically & Terminally Ill Patients? : The Dartmouth Institute for Health Policy & Clinical Practice.
5 : Is Quebec Dr. Assisted End of Life Law Too Restrictive? : University of Montreal.
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