End of Life Discussions for Heart Failure

Author: The Heart Failure Society of America
Published: 2011/09/20 - Updated: 2022/07/13
Topic: End-of-Life - Palliative Care - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Palliative care for advanced heart failure patients and reevaluating when a physician should discuss a patient's goals to determine treatment. 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

Defining Heart Failure

Heart Failure: Heart failure is a progressive condition in which the heart muscle becomes weakened after injury, most commonly from a heart attack or high blood pressure. It 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 the early stages of the condition are crucial to slowing, stopping, or in some cases reversing progression, improving quality of life, and extending life expectancy.

Introduction

The 15th Annual Scientific Meeting of the Heart Failure Society of America (HFSA) included 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 focused on palliative care for advanced heart failure patients and reevaluate when a physician should discuss a patient's goals to determine treatment.

Focus

"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 discussed Stage D heart failure patients and provided 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 introduced studies that proved 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 addressed the "how" and the "when" of palliative care discussions. He argued that doctors should have these conversations earlier in patients' diseases when their conditions are more stable.

Goldstein also asserted 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?"

Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by The Heart Failure Society of America and published on 2011/09/20, this content may have been edited for style, clarity, or brevity. For further details or clarifications, The Heart Failure Society of America can be contacted at hfsa.org NOTE: Disabled World does not provide any warranties or endorsements related to this article.