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INTEGRATED END-OF-LIFE CARE IN ADVANCED CONGESTIVE HEART FAILURE: WHERE ARE WE NOW?

Helen Senderovich

 Introduction: Congestive Heart Failure (CHF) is an increasingly prevalent terminal illness in a globally aging population. Despite optimal medical management, prognosis remains poor – a fact seldom communicated to patients and/or their families. Evidence suggests numerous benefits of palliative care consultation in advanced CHF but to date, their services remain woefully underutilized. Objectives: To identify specific challenges to accessing and implementing palliative care in patients with advanced CHF and to use this information to formulate recommendations for practice. Methods: Literature review whereby recommendations for practice were formulated on the basis of primary quantitative/ qualitative data and consensus expert opinion. Results: Accessing palliative care services for patients with CHF remains a challenge for numerous factors including prognostic uncertainty, misconceptions about what palliative care is, and difficulty recognizing when a patient is suitable for referral. Strategies to improve access/delivery of palliative care to this population include education and proper discussion about prognosis/goals of care. A team-based approach is essential as we move towards a model where symptom palliation exists concurrently with active medical disease-modifying treatment. Conclusion: Despite evidence that palliative care has a role in improving symptom control and overall quality of life in patients with end-stage CHF, a multitude of challenges exist and this ultimately hinders access to palliative care services. Education to abolish pre-existing misconceptions about the role of palliative care and a movement towards a team-based approach focused on simultaneous palliative and traditional medical care will undoubtedly improve access to and benefit from palliative care services in this population.

This work is partly presented at 2nd Global Congress on Hospice & Palliative Care on September 29-30, 2016 held in Toronto, Canada