How Medicine Has Changed the End of Life for Patients With Cardiovascular Disease

Area of Science:

• Cardiology
• Palliative Care
• Medical Ethics

Background:

• Medical advancements have increased lifespan but also years lived with disability.
• Cardiovascular disease (CVD) patients experience a clustering of illnesses late in life.
• End-of-life care for CVD patients is often associated with increased symptoms and reduced access to home death and palliative care.

Purpose of the Study:

• To highlight the unique challenges in end-of-life care for patients with cardiovascular disease.
• To address disparities in end-of-life care influenced by social determinants.
• To explore ethical considerations in modern end-of-life medical care, particularly concerning cardiac devices.

Main Methods:

• Review of current literature on end-of-life care in cardiovascular disease.
• Analysis of the impact of social determinants on care disparities.
• Examination of ethical dilemmas related to deactivating cardiac devices (pacemakers, defibrillators, mechanical circulatory support).

Main Results:

• Patients with cardiovascular disease are more symptomatic at the end of life.
• Disparities in end-of-life care are exacerbated by social determinants.
• Caregiver burden is increasing due to complex and prolonged care needs.
• New ethical challenges arise from managing advanced cardiac technologies at life's end.

Conclusions:

• Improving end-of-life care for cardiovascular disease patients requires a multi-faceted approach.
• Key strategies include enhancing palliative care metrics, education, and research.
• Addressing disparities and innovating care delivery and reimbursement models are essential.
• Ethical frameworks for managing cardiac devices at end-of-life need development.