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Healthcare providers can improve the quality of life and reduce symptom burden for heart failure patients by integrating palliative principles and referring to specialists when necessary.

Heart failure is an increasingly common condition among America’s aging population. According to the American Heart Association (AHA), these patients often experience severe symptoms such as shortness of breath, cough, nausea, fatigue, pain, depression, and anxiety. This population also tends to have higher hospitalization rates.

Given these factors, many of these patients will need to receive some form of palliative care, Dr. Larry Allen, chief of cardiology at the University of Colorado, said in a recent AHA webinar. Allen is also chair of the AHA’s Clinical Cardiology Council.

“Heart failure is associated with significant mortality, high symptom burden, low functional status and quality of life, frequent hospitalizations, and relatively high patient mortality,” Allen said in the webinar. “Guideline-based heart failure treatment can increase survival rates, reduce symptoms such as shortness of breath and swelling, and improve quality of life. People living with heart failure continue to have unmet care needs. “We are facing uncertainty about our prognosis. And palliative care can help.”

Palliative care can help in many ways. In addition to symptom management, integrating palliative care into heart failure treatment not only helps identify patient care goals and establish an advance care plan, but also addresses the patient’s psychosocial needs and social aspects of health. Determinants can be addressed and support provided to families, Allen noted. .

The need for this care is increasing. According to the Centers for Disease Control and Prevention (CDC), cardiovascular disease is the leading cause of death among American adults. Approximately 6.7 million U.S. adults have heart failure, and that number is expected to rise to 8.5 billion by 2030, a 2023 study published in the Journal of Cardiac Failure found. became.

Research shows hospitalization rates are also rising. The number of people hospitalized for heart failure rose from just under 1.1 million in 2008 to nearly 1.3 million in 2018. A similar trend was observed in readmission rates.

By 2030, direct medical costs associated with heart failure are expected to reach $53 billion and indirect costs will exceed $70 billion.

Current heart failure clinical practice guidelines also call for palliative support, including those from the AHA, American Heart Failure Association, and American College of Cardiology. However, health care providers must distinguish between “primary palliative care,” where palliation is integrated into routine services, and “secondary palliative care,” where a specialized team is involved.

“Primary palliative care is something we all do. We think about ways to alleviate suffering, we help patients think about the end of life and what death is like, and we help patients with symptoms including depression and anxiety, such as shortness of breath. “Thinking about how to treat basic symptoms is a fundamental knowledge and skill for all medical professionals,” Allen said. “A palliative care specialist is a clinician who has actually had specialized training and experience in caring for seriously ill and dying patients. So it’s a team approach. We start with palliative care, and if the situation gets really complicated, we bring in a palliative care specialist to help.”

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