Referral for palliative care in advanced heart failure

摘要

Heart failure is a serious clinical condition that may be challenging to treat near end of life due to symptom burden, psychological concerns and social support issues. Referral for palliative care is uncommon and, when a patient is referred for services, it may occur very close to the patient's death, limiting palliative and support services associated with specialty programs. Chronic heart failure management guidelines were developed by heart failure experts and based on best evidence. However, since evidence in end-of-life and palliative care themes are limited, current heart failure guidelines specific to end of life and palliation are also limited in scope and detail. Many guidelines do not specify prognostic markers or other indicators for referral or consultation with palliative medicine teams. Likewise, many do not emphasize supportive care beyond management of dyspnea and pain. This paper describes current issues that limit referral to palliative care and offers insight for opportunities to improve patient-centered care through research.