Abstract
Heart failure (HF), a clinical syndrome with a variable trajectory has become more
common. As people with HF experience functional decline during periods of deterioration
in their HF status, or with aging, their needs for palliative care increase. In this
review we consider the palliative aspects of evidence-based HF care, which benefit
patients while also addressing the underlying etiology of the HF. We also identify
symptoms common to patients with HF and management beyond evidence-based HF care.
Prognostic models and tools to identify patients appropriately evaluated by HF specialty
experts might help clinicians understand the patient’s status. Rather than trying
to identify a point at which palliative care should be included in care for a patient
with HF, we suggest that identifying specific needs of the patient and family is a
better way to target palliative care interventions. We review available publications
that have explored integration of palliative care into HF care, and propose an outpatient
clinic model to assess needs and symptoms and direct HF specialist or palliative care
on the basis of this assessment.
Résumé
L’insuffisance cardiaque (IC), qui est un syndrome clinique à la trajectoire variable,
est de plus en plus fréquente. Alors que les personnes atteintes d’IC subissent un
déclin fonctionnel durant les périodes de détérioration de leur état d’IC, ou en raison
du vieillissement, leurs besoins en soins palliatifs augmentent. Dans la présente
revue, nous considérons la dimension palliative des soins en IC fondés sur des données
probantes, qui bénéficient les patients tout en remédiant également à l’ensemble des
causes sous-jacentes de l’IC. Nous déterminons aussi les symptômes communs aux patients
atteints d’IC et la prise en charge au-delà des soins en IC fondés sur des données
probantes. Les modèles et les outils de pronostic pour déterminer les patients convenablement
évalués par les experts en IC pourraient aider les cliniciens à comprendre l’état
du patient. Plutôt que d’essayer de trouver le moment auquel les soins palliatifs
devraient être intégrés aux soins d’un patient atteint d’IC, nous proposons de déterminer
les besoins particuliers du patient et de la famille pour parvenir à mieux cibler
les interventions en soins palliatifs. Nous passons en revue les publications disponibles
qui ont permis d’explorer l’intégration des soins palliatifs aux soins en IC, et proposons
un modèle de consultations externes pour évaluer les besoins et les symptômes, et
les soins directs du spécialiste en IC ou les soins palliatifs en fonction de cette
évaluation.
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Article info
Publication history
Published online: May 12, 2020
Accepted:
May 5,
2020
Received:
February 4,
2020
Footnotes
See page 1057 for disclosure information.
Identification
Copyright
Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
