Palliative Care Can Improve Health Outcomes for Patients With Cardiovascular Disease

A scientific statement from the American Heart Association (AHA) indicates that integrating palliative care into a patient’s treatment plan can improve quality of life, reduce depression and anxiety, improve spiritual well-being, and lower the risk for hospital readmission for people with advanced heart disease. The authors suggest that palliative care may benefit patients with cardiovascular disease (CVD), including coronary heart disease, heart valve disease, pulmonary arterial hypertension, and heart failure.

Despite the evident benefits of palliative care, it is often underutilized in populations with heart disease, particularly among underrepresented racial and ethnic groups. Image Credit: © Jack Fotografo - stock.adobe.com

Heart disease is the leading cause of death among men and women in the US since 1921, affecting 1 individuals every 33 seconds. It describes a range of conditions, diseases, or symptoms, such as arrhythmias, congenital heart defects, coronary artery disease, heart attacks, and stroke. Treatment of heart diseases typically includes a combination of lifestyle modifications, including diet, exercise, and smoke cessation, with prescribed medications. In more serious cases, certain procedures or surgeries may be needed to remedy symptoms and prevent worsening disease.^1-3

According to the AHA, integrating a palliative care approach to medication management into cardiovascular (CV) treatment regimens is an effective way to improve symptoms and quality of life for patients with heart disease. Palliative care is the holistic treatment of patients with severe health-related symptom attributable to illness. It requires a team of health care providers, such as pharmacists, doctors, pain management specialists, or social workers to address the physical, mental, and emotional wellbeing of patients enduring disease or treatment. Through palliative care, patients can receive effective pain and medications management, as well as get connected to specialized mental health services.^4,5

Palliative pharmacotherapy is a crucial care component to treat CVD; however, there is little existing literature to effectively guide clinicians through safe and efficacious de-prescription or de-escalation of specific treatments. The scientific statement is intended to serve as a resource for clinicians caring for patient with CVD and provides practical suggestions for incorporating palliative methods to medication management, a critical component of palliative care.⁶

According to the authors, through palliative care, clinicians can enhance the existing guideline-directed medical therapy or evidence-based therapies to safely de-prescribe CV medications. They outline 4 ways that palliative care complements CV care: (1) reduction of physical symptom burden, (2) management of emotional and spiritual distress, (3) provide sufficient support for caregivers, and (4) assist patients in decisions that align with their care goals.⁶

"It is critical for patients to be fully informed about their diagnosis and how medication management may change throughout the disease progression so they have ample time to set and share their goals," Katherine E Di Palo, PharmD, MBA, MS, FAHA, said in a news release. "These goals often include reducing symptoms such as shortness of breath, fatigue and pain, as well as improving sleep, mood and appetite."⁵

Despite the evident benefits of palliative care, it is often underutilized in populations with heart disease, particularly among underrepresented racial and ethnic groups, according to the report. The statement indicates that the patients who are more likely to receive referrals to palliative care are predominantly White, have a higher socioeconomic status, and are more likely to receive their care at academic medical centers. This has significant implications for patients from underrepresented racial and ethnic groups, who are less likely to receive palliative care, leading to poorer outcomes and an increased risk of early death.^5,6

Providing relief for symptoms of CVD is crucial to improving health outcomes and quality of life for patients, as well as encouraging prolonged life. Palliative care is a critical form of specialized care and places the physical, mental, emotional, and spiritual wellness of every patient at the center. With a dynamic, multi-faceted approach to treatment supported by a diverse team of clinicians, patients with CVD can experience better care and better outcomes.

REFERENCES

1. Heart disease facts. CDC. May 15, 2024. Accessed August 21, 2024. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html

2. What is cardiovascular disease? American Heart Association. January 10, 2024. Accessed August 21, 2024. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease

3. Martin S, Aday A, Almarzooq Z, et al. 2024 heart disease and stroke statistics: a report of us and global data from the american heart association. Circulation. January 24, 2024. doi:10.1161/CIR.0000000000001209

4. Palliative care. Mayo Clinic. June 6, 2023. Accessed August 21, 2024. https://www.mayoclinic.org/tests-procedures/palliative-care/about/pac-20384637#:~:text=Overview,your%20condition%20can%20be%20cured

5. Palliative care underused for people with heart disease, report finds. American Heart Association News. July 1, 2024. Accessed August 21, 2024. https://www.heart.org/en/news/2024/07/01/palliative-care-underused-for-people-with-heart-disease-report-finds

6. Di Palo K, Feder S, Baggenstos Y, et al. Palliative pharmacotherapy for cardiovascular disease: a scientific statement from the american heart association. Circ. Cardiovasc Qual. July 1, 2024. doi:10.1161/HCQ.00000000000001