Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 70, Issue 10, Pages 1276-1289Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2017.07.735
Keywords
disability; disparities; heart failure; hospice; left ventricular assist device; palliative care
Categories
Funding
- American Heart Association
- AstraZeneca
- Luitpold
- Novartis
- Merck
- National Heart, Lung, and Blood Institute
- Patient Centered Outcomes Research Institute
- Janssen
- St. Jude
- ZS Pharma
- National Institutes of Health
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Advances in medicine have changed how patients experience the end of life. With longer life spans, there has also been an increase in years lived with disability. The clustering of illnesses in the last years of life is particularly pronounced in patients with cardiovascular disease. At the end of life, patients with cardiovascular disease are more symptomatic, less likely to die at home, and less likely to receive high-quality palliative care. Social determinants have created widening disparities in end-of-life care. The increasing complexity and duration of care have resulted in an epidemic of caregiver burden. Modern medical care has also resulted in new ethical challenges, for example, those related to deactivation of cardiac devices, such as pacemakers, defibrillators, and mechanical circulatory support. Recommendations to improve end-of-life care for patients with cardiovascular disease include optimizing metrics to assess quality, ameliorating disparities, enhancing education and research in palliative care, overcoming disparities, and innovating palliative care delivery and reimbursement. (J Am Coll Cardiol 2017;70:1276-89) (C) 2017 by the American College of Cardiology Foundation.
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