Review Article
Palliative Care for Patients With Advanced Heart Disease

https://doi.org/10.1053/j.jvca.2018.04.047Get rights and content

Over the past 2 decades, the discipline of palliative care has evolved and expanded such that it is now the standard of care for a variety of acute and chronic processes. Although there are recommendations encouraging incorporation of palliative care into the routine management of patients with chronic cardiac processes, such as congestive heart failure, implementation has been challenging, and nowhere more so than in the cardiac surgical population. However, as the boundaries of surgical care have expanded to include progressively more complex cases, increasing attention has been given to the integration of palliative care into their management. In this review article, the authors describe the existing evidence for palliative care team involvement in patients with non-operative and surgical cardiac diseases and examine future directions for growth in this field.

Section snippets

Introduction/ Background

Palliative care (PC), also referred to as supportive care,1 has been defined by the World Health Organization as “… an approach that improves the quality of life (QOL) of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”2 PC emphasizes reduction of suffering and

Methods

The following databases were searched for relevant reports: MEDLINE (1966 to January 2018); Google Scholar, and CINAHL (Cumulative Index of Nursing and Allied Health Literature; 1982 to January 2018). The subject heading “palliative care” was combined with the headings “heart failure,” “cardiac surgery,” “left ventricular assist device,” “transcatheter aortic valve replacement,” “extracorporeal membranous oxygenation,” “valve disease,” “ischemic heart disease,” and “heart transplant.” The

Conclusions

Although patients with advanced cardiac disease may benefit from PC in many contexts, the transition from recommendation to implementation is challenging, and few studies assessing the role and impact of PC in cardiac surgical patients have been published. Existing research is predominantly focused on perioperative advance care planning. The complexities of integrating PC into the routine care of patients with HF suggest that the expansion of this role may be complex. Further research is needed

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