Implementing patient-centred palliative care therapies, which include prescribing, adjusting, or discontinuing medications as needed, can control symptoms and improve the quality of life for those with heart disease. This approach is outlined in the new scientific statement “Palliative Pharmacotherapy for Cardiovascular Disease” from the American Heart Association, published in Circulation: Cardiovascular Quality and Outcomes. The statement reviews the current evidence surrounding the benefits and risks of cardiovascular and essential palliative medications, offering guidance for healthcare professionals to integrate palliative methods into holistic medication management across all stages of a patient’s health conditions. It also emphasises the importance of shared decision-making and goal-oriented care.
Palliative care is specialised medical care that alleviates symptoms and enhances the quality of life for those suffering from serious health-related issues. This type of care is especially beneficial for patients with various cardiovascular diseases, including coronary heart disease, valvular heart disease, pulmonary arterial hypertension, and heart failure. These conditions, which significantly impair quality of life, require ongoing treatment, are generally progressive, and are associated with high mortality rates. Often, the progression of these conditions is unpredictable, characterised by worsening symptoms that frequently lead to hospital admissions.
Integrating palliative care into standard cardiovascular treatment helps reduce physical symptoms, manage emotional distress, and aids patients in aligning treatment decisions with their care goals. This approach can be incorporated at any stage of heart disease, from chronic, stable conditions to advanced and end-stage disease, supporting a more goal-oriented, patient-centred treatment approach. Despite its benefits, fewer than 20% of individuals with end-stage heart disease receive palliative care.
Significant disparities in cardiovascular care and outcomes persist, influenced by race, ethnicity, gender, and social determinants of health. Those who are referred to palliative care tend to be predominantly white, from higher socioeconomic backgrounds, and more likely to receive care at academic medical centres. Patients from underrepresented racial and ethnic groups are less likely to receive palliative care, leading to poorer outcomes and increased risk of early mortality.
Dr. Katherine E. Di Palo, Chair of the statement writing group, emphasises the importance of fully informing patients about their diagnosis and potential changes in medication management as their disease progresses. This knowledge allows patients to set and share their care goals, including reducing symptoms such as shortness of breath, fatigue, and pain and improving sleep, mood, and appetite. To achieve these goals, cardiovascular medications that provide symptom relief, like diuretics for managing fluid retention in heart failure, should be prioritised for patients with advanced heart disease. Additionally, incorporating palliative medicines alongside evidence-based cardiovascular therapies can optimise symptom management and enhance quality of life.
A team-based approach is essential for managing the complexities of medication in heart disease, involving collaboration among multidisciplinary clinicians from primary care, cardiology, and palliative care. Given the rapid changes in health status that patients may experience, ongoing discussions are crucial to ensure that treatment plans align with the patient’s preferences and priorities. Clinicians should routinely evaluate—and communicate—the potential risks, benefits, and expected timeframe for each medication’s effectiveness.
Deprescribing and de-escalating medications are also critical components of palliative medication management for heart disease patients. Deprescribing involves tapering, withdrawing, or discontinuing a medication to improve outcomes while de-escalating focuses on reducing the dosage or switching medications based on the patient’s response. Several scenarios where deprescribing might be considered include situations where the expected time to benefit from a medication exceeds the patient’s life expectancy. Future research is needed to determine the most effective ways to provide timely and targeted access to palliative medication management, particularly for patients with advanced heart disease from under-represented racial and ethnic groups who are less likely to receive palliative care or may face barriers to accessing it.
More information: Katherine E. Di Palo et al, Palliative Pharmacotherapy for Cardiovascular Disease: A Scientific Statement From the American Heart Association, Circulation. DOI: 10.1161/HCQ.0000000000000131
Journal information: Circulation Provided by American Heart Association
