People with critical cardiovascular disease may benefit from palliative care

Associated Press

15-05-2025

Statement Highlights:
Embargoed until 4:00 a.m. CT/5:00 a.m. ET Thursday, May 15, 2025
( NewMediaWire ) - May 15, 2025 - DALLAS — Palliative care may help relieve symptoms and improve quality of life for people with cardiovascular disease and ensure that treatment is aligned with the patient's personal beliefs and values throughout all stages of illness, whether they are hospitalized in a cardiac intensive care unit or receiving outpatient care, according to a new American Heart Association scientific statement published today in the Association's flagship, peer-reviewed journal Circulation.
The new scientific statement, 'Palliative and End-of-Life Care During Critical Cardiovascular Illness,' suggests strategies to integrate palliative care principles into the management of patients with critical cardiovascular illness. Palliative care aims to improve quality of life; to minimize physical, emotional and spiritual distress; to facilitate complex discussions regarding prognosis and goals of care; and to provide emotional and psychosocial support to patients, family members and caregivers throughout all stages of illness, not just at the end of life. Currently, palliative care is most widely used caring for patients with cancer.
'We need to better understand the benefits of palliative care in a broad range of cardiovascular conditions and particularly for patients with acute, critical illness,' said volunteer Chair of the scientific statement writing group Erin A. Bohula, M.D., D.Phil., an assistant professor of medicine at Harvard Medical School and critical care cardiologist at Brigham & Women's Hospital, both in Boston. 'People with a variety of heart conditions face increasing symptoms, functional limitations and a need to align care with their personal preferences, beliefs and values – whether that's to do everything possible or to prioritize comfort and quality of life. A patient-centered approach needs to be considered, particularly when making decisions about available and sometimes invasive care options as their condition advances.'
Palliative care for specific cardiovascular conditions
The statement authors emphasize that palliative care can be provided in addition to evidence-based treatments at any stage of a person's illness, from intensive care to outpatient care. However, providing palliative care for cardiovascular disease can be challenging because the progression of the illness can be unpredictable, and there may be sudden, urgent situations requiring hospitalization and/or admission to the cardiac intensive care unit. These can result in new symptoms such as loss in physical function and may lead to unexpected end-of-life situations that necessitate more intensive support from cardiology and palliative care professionals.
In addition, many patients admitted to cardiac intensive care units are older (with a median age of 65 years), more frail and critically ill, with advanced and complex cardiovascular conditions, and they may also have multiple non-cardiac conditions. Palliative care health professionals need to be knowledgeable about the medical prognosis and quick decision-making required in cardiac intensive care units, including the management of life-sustaining technologies and advanced cardiac interventions.
Palliative care can be integrated into care to manage symptoms and improve quality of life for patients with different types of cardiovascular disease:
Accessibility challenges and ethical considerations
Despite the growing evidence about the benefits of palliative care, many people with cardiovascular disease have limited access to palliative care specialists. Rates of referral to palliative care for patients with cardiovascular disease are low and often delayed compared to patients with cancer.
Due to delayed referrals and the scarcity of palliative care resources, it can be difficult for individuals with cardiovascular disease to access outpatient palliative care. Inpatient palliative care services may also be limited in settings outside of large hospitals. The statement suggests integrating palliative care services into heart failure clinics and post-discharge services for patients recently hospitalized in the cardiac intensive care unit, creating a transition from inpatient to outpatient care.
There are also complex ethical considerations for patients with advanced cardiovascular disease, particularly in relation to life-sustaining interventions. Medical codes of ethics emphasize promoting patient well-being, avoiding harm and respecting patient autonomy; however, these can sometimes seem at odds in the setting of the cardiac intensive care unit or treating a patient with end-stage cardiovascular disease. For example, deactivating the shocking function of an implanted cardiac defibrillator may increase the risk of death if a fatal arrhythmia occurs, while at the same time minimizing a patient's pain by avoiding the delivery of multiple shocks.
A separate, recently published American Heart Association scientific statement on palliative care and advanced cardiovascular disease highlights the importance of shared decision-making involving the patient and family as the disease progresses. When a patient's symptoms become more severe and difficult to manage, discussions about changing or discontinuing certain treatments may be necessary based on the patient's personal preferences, quality of life, prognosis and advanced care documents.
Education for cardiovascular specialists
While palliative care is not a recognized subspecialty of cardiology, its approaches can be offered by cardiovascular clinicians with specialized training in palliative care and in consultation with palliative care specialists. However, only a small fraction of health care professionals who complete a cardiology fellowship receive either required or elective training in palliative care.
The scientific statement identifies several basic palliative care competencies needed by cardiovascular specialists:
'It is critical that all cardiac intensive care unit and acute care professionals have the tools and knowledge to provide the basic tenets of palliative care, such as symptom management and ensuring that care is appropriate and aligns with the patient's personal choices. As the field of cardiac critical care advances, incorporating palliative care principles ensures a holistic approach to providing care and addressing the complex needs of these patients during a health care crisis or at the end-of-life,' said Bohula.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, and the Council on Cardiovascular and Stroke Nursing. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association's official clinical practice recommendations.
Co-authors are Vice-Chair Abdulla A. Damluji, M.D., Ph.D., M.B.A., FAHA; Michael J. Landzberg, M.D.; Venu Menon, M.D., FAHA; Carlos L. Alviar, M.D.; Gregory W. Barsness, M.D., FAHA; Daniela Crousillat, M.D.; Nelia Jain, M.D., M.A.; Robert Page II, Pharm.D., M.S.P.H., FAHA; and Rachel Wells, Ph.D., M.S.N. Authors' disclosures are listed in the manuscript.
The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content. Overall financial information is available here.
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