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Palliative Pharmacotherapy for Cardiovascular Disease: A Scientific Statement From the American Heart Association
Insights
Palliative pharmacotherapy, using cardiovascular and palliative medicines, can improve quality of life for advanced cardiovascular disease patients. This approach, including de-escalation and shared decision-making, is underutilized but essential for symptom control.
Area of Science:
- Cardiology
- Palliative Care
- Pharmacotherapy
Background:
- Cardiovascular disease (CVD) significantly impacts health and quality of life, particularly in older adults.
- Despite life-prolonging therapies, CVD progression is unpredictable, leading to worsening symptoms, hospitalizations, and high healthcare costs.
- Palliative medication management is underused in CVD compared to other serious illnesses.
Purpose of the Study:
- To describe palliative pharmacotherapy for cardiovascular disease, integrating cardiovascular and palliative medicines.
- To review evidence for guideline-directed and evidence-based therapies in end-stage cardiovascular conditions.
- To provide guidance on medication de-escalation and deprescribing within a palliative framework.
Main Methods:
- Literature review and evidence synthesis on palliative pharmacotherapy in CVD.
- Analysis of guideline-directed medical therapies for end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and cardiomyopathies.
- Emphasis on shared decision-making and goal-oriented care principles.
Main Results:
- Palliative pharmacotherapy, combining cardiovascular and palliative agents, can synergistically control symptoms and enhance quality of life.
- Evidence supports specific medical therapies for advanced CVD, with considerations for deprescribing.
- Shared decision-making is crucial for patient-centered medication management.
Conclusions:
- Integrating palliative pharmacotherapy into cardiovascular care is vital for symptom management and improved quality of life.
- A patient-centered approach emphasizing shared decision-making and goal-oriented care is essential.
- Further research and clinical adoption of palliative strategies in CVD are warranted.
Abstract:
Cardiovascular disease exacts a heavy toll on health and quality of life and is the leading cause of death among people ≥65 years of age. Although medical, surgical, and device therapies can certainly prolong a life span, disease progression from chronic to advanced to end stage is temporally unpredictable, uncertain, and marked by worsening symptoms that result in recurrent hospitalizations and excessive health care use. Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential to the iterative process of patient-centered medication management across the spectrum of cardiovascular disease.
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