Aggressive treatments for advanced heart failure include complex pacemakers, implantable defibrillators and mechanical devices to pump blood through the body. However, some patients with advanced heart failure may prefer to emphasize symptom relief, comfort and support along with medical therapy, according to Larry Allen, M.D., MHS, assistant professor of medicine at the University of Colorado Anschutz Medical Center in Aurora.
Enter the field of palliative care, a specialized approach designed to prevent and relieve suffering and support families. A palliative care team can help clarify patients’ desires and help match those to treatment options.
For example, a palliative care specialist could weigh in on the decision to receive an implantable defibrillator, Allen said. The devices deliver an electric shock to a patient whose heart is in ventricular tachycardia — meaning it beats very quickly and can’t pump blood effectively.
“But implantable defibrillators don’t improve how people feel when they’re not in ventricular tachycardia,” he said. “If you’re elderly and your quality of life is not that good and there’s a chance you could die in your sleep, do you want your implanted defibrillator to bring you back?”
Palliative care specialists may include a doctor, nurse, social worker, chaplain, physical therapist, occupational therapist, dietitian and psychologist, who will all work with patients, cardiologists and other medical providers to make decisions about medical treatment. The team may also give emotional and spiritual support to patients and their families.
“When patients and doctors are making medical decisions concordant with their fundamental values, their symptoms are better treated, they feel better and have higher overall satisfaction,” Allen said. “We have a system of care that’s pretty aggressive, which is helpful under the right circumstances, but some patients may be getting therapy they might not need or want.”
According to the American Heart Association, palliative care can provide:
- Relief from pain and symptoms of heart failure;
- Emotional and spiritual support for patients and families;
- Help with making complex treatment decisions;
- Assistance with practical issues, such as advance directives or insurance; and
- Support services for caregivers, such as respite care and grief counseling.
Palliative should not be confused with hospice care, typically provided when a patient has six months or less to live.
Allen says palliative care, however, should not be delayed until a patient is diagnosed with advanced heart failure.
“In heart failure, there are a lot of palliative care needs because patients have a lot of symptoms and it’s a deadly disease,” he said. “We are more likely to have good healthcare outcomes when we get patients palliative care early, so patients can define their goals. Failures are more common when palliative care is not done at all or it happens at the very end of life. We want to get it to the right people at the right time,” Allen said.
Heart failure is a progressive condition that occurs when the heart can’t pump enough blood through the body, which causes shortness of breath, swelling and fatigue. According to the Centers for Disease Control and Prevention, the risk of heart failure increases with age after 50, and about half of all heart failure patients will die within 5 years.
For more information: