End-of-life care in patients with heart failure

David J. Whellan, Sarah Goodlin, Michael G. Dickinson, Paul A. Heidenreich, Connie Jaenicke, Wendy Gattis Stough, Michael W. Rich

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Stage D heart failure (HF) is associated with poor prognosis, yet little consensus exists on the care of patients with HF approaching the end of life. Treatment options for end-stage HF range from continuation of guideline-directed medical therapy to device interventions and cardiac transplantation. However, patients approaching the end of life may elect to forego therapies or procedures perceived as burdensome, or to deactivate devices that were implanted earlier in the disease course. Although discussing end-of-life issues such as advance directives, palliative care, or hospice can be difficult, such conversations are critical to understanding patient and family expectations and to developing mutually agreed-on goals of care. Because patients with HF are at risk for rapid clinical deterioration or sudden cardiac death, end-of-life issues should be discussed early in the course of management. As patients progress to advanced HF, the need for such discussions increases, especially among patients who have declined, failed, or been deemed to be ineligible for advanced HF therapies. Communication to define goals of care for the individual patient and then to design therapy concordant with these goals is fundamental to patient-centered care. The objectives of this white paper are to highlight key end-of-life considerations in patients with HF, to provide direction for clinicians on strategies for addressing end-of-life issues and providing optimal patient care, and to draw attention to the need for more research focusing on end-of-life care for the HF population.

Original languageEnglish (US)
Pages (from-to)121-134
Number of pages14
JournalJournal of Cardiac Failure
Volume20
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Terminal Care
Heart Failure
Patient Care Planning
Patient Care
Advance Directives
Therapeutics
Equipment and Supplies
Patient-Centered Care
Hospices
Sudden Cardiac Death
Heart Transplantation
Palliative Care
Consensus
Communication
Guidelines
Research

Keywords

  • Advanced heart failure
  • end-of-life care
  • hospice
  • palliative care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Whellan, D. J., Goodlin, S., Dickinson, M. G., Heidenreich, P. A., Jaenicke, C., Stough, W. G., & Rich, M. W. (2014). End-of-life care in patients with heart failure. Journal of Cardiac Failure, 20(2), 121-134. https://doi.org/10.1016/j.cardfail.2013.12.003

End-of-life care in patients with heart failure. / Whellan, David J.; Goodlin, Sarah; Dickinson, Michael G.; Heidenreich, Paul A.; Jaenicke, Connie; Stough, Wendy Gattis; Rich, Michael W.

In: Journal of Cardiac Failure, Vol. 20, No. 2, 02.2014, p. 121-134.

Research output: Contribution to journalArticle

Whellan, DJ, Goodlin, S, Dickinson, MG, Heidenreich, PA, Jaenicke, C, Stough, WG & Rich, MW 2014, 'End-of-life care in patients with heart failure', Journal of Cardiac Failure, vol. 20, no. 2, pp. 121-134. https://doi.org/10.1016/j.cardfail.2013.12.003
Whellan DJ, Goodlin S, Dickinson MG, Heidenreich PA, Jaenicke C, Stough WG et al. End-of-life care in patients with heart failure. Journal of Cardiac Failure. 2014 Feb;20(2):121-134. https://doi.org/10.1016/j.cardfail.2013.12.003
Whellan, David J. ; Goodlin, Sarah ; Dickinson, Michael G. ; Heidenreich, Paul A. ; Jaenicke, Connie ; Stough, Wendy Gattis ; Rich, Michael W. / End-of-life care in patients with heart failure. In: Journal of Cardiac Failure. 2014 ; Vol. 20, No. 2. pp. 121-134.
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