Palliative Care Strategies Can Improve the Management of Cardiovascular Disease

Patients with cardiovascular disease (CVD) may benefit from palliative care therapy, according to the authors of a scientific statement from the American Heart Association (AHA) titled “Palliative Pharmacotherapy for Cardiovascular Disease.” Palliative care has a significant focus in medication management, shared decision-making, as well as goal-oriented care, which may provide patients with CVD relief from symptoms and enhanced quality-of-life.

Palliative care has many benefits when integrated with standard-of-care treatments for CVD, including the reduction of physical symptoms, improved management of emotional distress, and more assistance for patients during treatment regimen decisions. Image Credit: © Peakstock - stock.adobe.com

CVD is the leading cause of death in the United States, accounting for approximately 928,741 deaths in 2020, and is expected to cost approximately $1.8 trillion dollars over the next 30 years. High blood pressure, high cholesterol, obesity, smoking, poor diet, and physical inactivity are factors that can increase the risk of developing CVD, which highlights that there are opportunities for individuals to reduce their risk and better manage instances of disease through lifestyle modifications and early intervention.^1-4

Standard-of-care treatment for CVD typically involves a combination of lifestyle changes, such as increased exercise, diet modifications, and stress management, paired with medicine. Common therapies that demonstrate success in treating and managing CVD include statins, nonstatins, beta blockers, or calcium channel blockers, which are prescribed to meet the unique needs of every patient. Due to the emphasis in medication management and shared decision-making, palliative care offers patients with CVD improved access to more personalized treatments and comprehensive guidance when managing and effectively integrating multiple treatment methods.^1-4

Palliative care is specialized care focused on symptom relief and quality-of-life enhancement for patients with complex, progressive illnesses, regardless of expected disease recovery or need for lifelong care. Results from prior studies have found that patients who received palliative care with their standard treatment had better quality of life and mood compared with patients who did not receive palliative care. Additionally, patients also reported improved ability to cope with their disease.^5,6

Palliative care has many benefits when integrated with standard-of-care treatments for CVD, including the reduction of physical symptoms, improved management of emotional distress, and more assistance for patients during treatment regimen decisions. Palliative care medicines—such as antidepressants, opioids for pain relief and breathing difficulties, and anti-nausea medications—can be complementary to standard CVD treatments when managing symptoms and improving quality-of-life. The statement outlines several examples for deprescribing practices and when deprescribing may be appropriate for patients, noting that palliative care can effectively help navigate de-escalating medications, especially in cases of polypharmacy.^5,6

Additionally, the statement noted disparities in care and outcomes related to ethnicity, gender, and social determinants of health. According to the authors, the majority of patients referred to palliative care are White, from higher socioeconomic statuses, and are more likely to receive care at academic medical centers, compared with patients from underrepresented racial and ethnic groups. Further research is required to determine the best ways to provide timely and targeted access to palliative care, especially to overcome the barriers underrepresented patients face, ensuring that every patient has access to personalized, effective, and quality care.⁵

“Given the complexities of medication management in people with heart disease, a team-based approach is urged,” said Katherine E. Di Palo, PharmD, MBA, MS, FAHA, senior director of Transitional Care Excellence at Montefiore Medical Center, assistant professor of medicine at Albert Einstein College of Medicine in New York City, and chair of the statement writing group, in a press release. “Collaboration between multidisciplinary clinicians across primary care, cardiology and palliative care is needed to deliver effective, person-centered care.”⁵

References

1. Heart disease and stroke statistics – 2023 update. American Heart Association. January 25, 2023. Accessed July 2, 2024. https://professional.heart.org/en/science-news/heart-disease-and-stroke-statistics-2023-update

2. Heart disease facts. CDC. May 15, 2024. Accessed July 2, 2024. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html

3. Coronary heart disease. National Heart, Lung, and Blood Institute. December 20, 2023. Accessed July 2, 2024. https://www.nhlbi.nih.gov/health/coronary-heart-disease/treatment

4. Population shifts, risk factors may triple U.S. cardiovascular disease costs by 2050. EurekAlert. June 4, 2024. Accessed July 2, 2024. https://www.eurekalert.org/news-releases/1046818

5. Understanding palliative care: it’s not what you think. American Lung Association. December 1, 2020. Accessed July 2, 2024. https://www.lung.org/blog/understanding-palliativecare#:~:text=Any%20person%20who%20has%20a,with%20lifelong%20or%20chronic%20conditions

6. Palliative care beneficial to manage symptoms, improve quality of life for people with CVD. American Heart Association. July 1, 2024. Accessed July 2, 2024. https://newsroom.heart.org/news/palliative-care-beneficial-to-manage-symptoms-improve-quality-of-life-for-people-with-cvd?preview=ca17&preview_mode=True