Meeting the Unmet Needs of Aging Heart Failure Patients: A Role for Palliative Care
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ELDERLY AND HEART DISEASE (K. DHARMARAJAN, SECTION EDITOR)
Meeting the Unmet Needs of Aging Heart Failure Patients: A Role for Palliative Care Lacey Clement 1 & Quinn Painter 1 & Jonathan A. Shaffer 1
Published online: 26 September 2016 # Springer Science+Business Media New York 2016
Abstract Older patients with heart failure suffer from many symptoms. Many patients and their families not only face heart failure-related symptoms, but also financial burdens, side effects from medication and treatment, changes in their normal routine, difficult medical decisions, and limited social support. Palliative care aims to alleviate the pain and distress associated with illnesses and these difficulties, especially in the context of chronic and progressive illness. There have been strides to increase palliative care services for heart failure patients, but many barriers exist such as misconceptions about symptom burden, unpredictability of disease course and prognosis, and ambivalence of providers to discuss difficult topics with patients. Although there has been increased recognition of palliative care services, especially in heart failure, there still exists a paucity of implementation and research of these services for patients. There is a need for larger scale, randomized clinical trials for palliative care programs and systematic guidelines to further the implementation and efficacy of palliative care services for older patients with heart failure.
Keywords Palliative Care . Heart Failure . Aging . Supportive Care . Patient-Centered Care
This article is part of the Topical Collection on Elderly and Heart Disease * Jonathan A. Shaffer [email protected] Lacey Clement [email protected] 1
Department of Psychology, University of Colorado Denver, Campus Box 173, PO Box 173364, Denver, CO 80217, USA
Introduction Heart failure (HF) is the end stage of all cardiovascular diseases and is a major cause of morbidity and mortality [1]. It affects ∼5.7 million patients in the USA alone, and its incidence approaches 10 per 1000 person-years after 65 years of age; both its prevalence and incidence are rising. In 2005, HF was listed on 1 in 8 US death certificates and was identified as the Bunderlying cause^ in 21 % of these certificates. HF symptoms are responsible for >11 million physician office visits per year [2], and HF-related hospital admissions have tripled from 1,274,000 in 1979 to 3,860,000 in 2004. Moreover, hospital readmission rates and mortality rates for older patients are almost 70 and 40 %, respectively, within 1 year of discharge [3]. The estimated direct expenditure of US healthcare dollars for HF symptom management is estimated to be anywhere from $20 billion to $56 billion [2, 4]. Although HF has been recognized by physicians for more than 2000 years, only in the past few decades has it been identified as a major public health concern. A major contributor to this increased interest is the high prevalence of HF in adults aged 65 and older. Normal aging processes are associated with extensiv
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