Canadian Journal of Cardiology


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      End-stage cardiac disease processes lead to progressive, symptomatic and complex end-of-life care. Associated with physical and emotional distress, advanced cardiac disease remains undertreated in the outpatient population that presents a unique symptom burden, increased caregiver demands, and variable disease trajectory, all leading to challenging prognostication. The palliative approach to care of cardiac life-limiting disease helps improve the quality of life for patients and their caregivers. Historically, the focus of palliative care has been malignant disease processes with clear transition points, rather than diseases with non-linear trajectories. Due to its varying clinical course and life-limiting progression, cardiac disease prognostication is difficult, thus challenging the norms of approaches to palliative care. Cardiologists, cardiac patients and their caregivers are confronted with the management of end-stage cardiac disease while respecting the wishes of patient and caregiver for quality palliative and end-of-life care.


      The University of Ottawa Heart Institute's (UOHI) innovative Cardiac Supportive and Palliative Care Program (CSPCP) provides specialized outpatient service for patients diagnosed with advanced cardiac disease. The program's goal is to initiate and bridge access to cardiac palliative care across Eastern Ontario. End-stage cardiac disease patients are referred for symptom management, goals of care discussion, advance care planning, community care coordination, caregiver support and end-of-life planning. In collaboration with UOHI allied health services and community resources, and under the direction of a Cardiologist with expertise in palliative care, the Advanced Practice Nurse (APN) is able to fulfill a supportive and consultative role. Advanced medical assessments, in-depth cardiac symptom management, and community care coordination support, respect, and honour the patient's goals of care. Using direct clinical and comprehensive care, the APN optimizes and synthesizes health information, provides patient and caregiver education, and ensures optimal end-stage cardiac palliative patient care. With this innovative model of care, the UOHI CSPCP has successfully met the needs of end-stage cardiac patients and their caregivers throughout Eastern Ontario.


      Through a complex case study, one is best able to understand the APN's role in facilitating excellent cardiac palliative care. Implementing CSPCP has allowed patients to explore their goals of care and advance care plans with the UOHI CSPCP team, optimize end-stage cardiac symptom burden, initiate home care services and provide quality end-of-life care.
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