Palliative Care in Decompensated Heart Failure Requiring Inotropic Therapy: Opportunities for Integration to Improve...

Area of Science:

• Cardiology
• Palliative Care
• Medical Ethics

Background:

• Advanced heart failure (HF) significantly impacts patient quality of life and survival.
• Hospitalizations and inotropic therapy in HF patients are associated with increased morbidity.
• Palliative care (PC) is underused in cardiology despite its potential to manage suffering.

Purpose of the Study:

• To assess the integration of PC in decompensated heart failure (HF) management.
• To identify opportunities for enhancing patient care through PC.
• To evaluate the impact of PC on decision-making and outcomes in HF patients.

Main Methods:

• Retrospective observational study of 492 decompensated HF patients on inotropic therapy (Feb 2015-May 2018).
• Analysis of PC referral rates, timing, and interventions.
• Evaluation of patient outcomes, including symptom management and 5-year survival.

Main Results:

• Only 23% of HF patients were referred to PC, with a median of 8 days before death.
• PC-referred patients showed increased involvement in decision-making and opioid use for symptom control (p<0.01).
• In-hospital mortality was 42%, and 5-year mortality was 80%.

Conclusions:

• Late referral of decompensated HF patients to PC limits its benefits.
• Enhanced PC education and integration strategies are needed.
• Improved PC integration may enhance outcomes for advanced HF patients.