Introduction on Management of Heart Failure in Patients Nearing the End of Life - There is So Much More To Do
In the infancy of the hospice and palliative care movements, Dame Cicely Saunders noted that terminally ill patients and their families were often told “there is nothing more to do.” Her unwavering belief was that those words betrayed the patient, and that “there is so much more to do.”1
Stage D heart failure (HF) is defined as HF in which refractory symptoms persist despite guideline-directed therapies.2 This stage of HF is highly morbid and is associated with a high burden of both physiologic and psychological suffering.3 Advances in care of cardiovascular diseases and an aging population have contributed to a burgeoning number of patients with Stage D HF. Current estimates of the number of patients who die from HF is approximately 60,000 per year versus approximately 300,000 per year who die with HF in the US (with a similar number in Europe).4 The fields of cardiology and palliative care have begun to recognize and address the complex needs of these patients. Their collaborative efforts have resulted in a growing body of literature aimed at providing guidance for practitioners caring for this population.5 This review will provide practitioners with focused recommendations for the care of individuals with HF who are nearing the end of life.