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Palliative care in end-stage heart failure

ESC Congress Report

  • It is important to identify "the point of no return."
  • Exercise is beneficial even in end-stage heart failure.
  • Good communication between cardiologists and the patients and family members improves outcomes.
Heart Failure (HF)

View the Slides from this session in ESC Congress 365

The beneficial impact of palliative care is widely recognized in heart failure (HF) patients and included in current guidelines for the diagnosis and treatment of HF. However, there are still important issues which remain unresolved. This session, co-chaired by Professor Tiny Jaarsma and myself, focused on palliative care in end-stage HF, with the goal of exploring the difficulties involved and providing practical suggestions.

The session opened with professor Marco Metra (Brescia, IT) who discussed the importance of identifying the “point of no return.” He also provided evidence-based, practical clinical advice. He explained how clinicians can use prognostic determinants to identify the end-stage of HF, e.g. the diuretic response, nutrition state, congestion and biomarkers.

Professor Sarah J Goodlin ( Portland, US) followed and noted that death rates vary, depending on resources and culture. She emphasized that RAAS blockade and exercise seem to be beneficial, even in advanced stage HF. She closed her presentation by highlighting that there are still a lot of unanswered questions when it comes to palliative care in HF.

Professor Anna Stromberg (Linkoping, SE) explained that there is room for improvement in the HF trajectory from diagnosis to the end of life. She referred to clinicians’ need for effective communication: “Talk and talk and walk the walk.” She concluded her presentation with the words of Epicurus (341-270 BC): “The art of living well and dying well are one.”

The session was brought to a close by Professor Mariell Jessup (Philadelphia, US) who started her presentation by showing how patients feel when they get defibrillated by their ICD and noting that sometimes patients experience those feelings in their last moments. She also pointed out that “difficult’’ conversations improve outcomes and said families want to talk about prognosis and possibilities in care.

I conclude by highlighting that even though palliative care is an important factor in the care of HF patients there are still obstacles regarding its implementation by cardiology health professionals. For that reason, there is a rising need for including palliative care in the curriculum of HF specialists.




Palliative care in end-stage heart failure

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.