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Posted By: Daniel Thibodeau, MHP, PA-C
July 19, 2019
As clinicians, we care for patients over the course of a lifetime and often face the reality of patients who are challenged with end-of-life (EOL) decision making. It’s a difficult topic to engage in with a patient, and one that is not done as often as it should be. It is estimated that less than 10% of the population with advanced heart disease (AHD) are receiving some form of palliative care, and most of it is done towards the EOL.
In the past, cardiologists had discussed the need to create a comprehensive guideline for palliative care of patients with cardiovascular disease, but a recent push to become more formalized is being discussed again. The discussion surrounds the need to create competencies that come to a consensus. According to a survey of cardiology fellows, 96% of those surveyed agreed that palliative care is important and needs to be a part of fellowship training. Currently, there is a lack of adequate training in this arena, and many patients are continuing with advanced treatment as the only option. This can lead to increased efforts that may be found futile, and the cost associated with this aggressive care can be high. This is especially true with AHDs like heart failure, where advanced treatments can prolong life without improvement in overall quality of life.
The average lifetime cost for a patient after the diagnosis of heart failure has been estimated to be $109,541. As one can imagine, as the illness progresses to its end stages, the costs can increase rapidly as extra efforts are taken. Given this situation, practitioners should consider learning more about palliative care and understanding the competencies needed to effectively communicate and work with patients and their families about EOL situations. It is not an easy task, but we have an obligation to discuss this with patients in order to treat them with compassion and consideration on the road ahead.
- Crousillat DR, Keeley BR, Buss MK, Zheng H, Polk DM, Schaefer KG. Palliative care education in cardiology. J Am Coll Cardiol. 2018;71:1391-1394.
- Dunlay SM, Shah ND, Shi Q, et al. Lifetime costs of medical care after heart failure diagnosis. Circ Cardiovasc Qual Outcomes. 2011;4:68-75.
- Gelfman LP, Kalman J, Goldstein NE. Engaging heart failure clinicians to increase palliative care referrals: overcoming barriers, improving techniques. J Palliat Med. 2014;17:753-760.
Filed under: Cardiometabolic