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Heart, Lung and Circulation

Integrating Heart Failure Palliative Care Delivery in an Uncertain Disease Trajectory

      Dying with end stage heart failure can be like a roller-coaster: a process punctuated by unpredictable episodes of acute deterioration, recovery, and often seemingly unexpected decline [
      • Rogers J.G.
      • Patel C.B.
      • Mentz R.J.
      • Granger B.B.
      • Steinhauser K.E.
      • Fiuzat M.
      • et al.
      Palliative care in heart failure: the PAL-HF randomized, controlled clinical trial.
      ,
      • Jha S.R.
      • Ha H.S.
      • Hickman L.D.
      • Hannu M.
      • Davidson P.M.
      • Macdonald P.S.
      • Newton P.J.
      Frailty in advanced heart failure: a systematic review.
      ,
      • Liu L.
      • Eisen H.J.
      Epidemiology of heart failure and scope of the problem.
      ]. This not-so-predictable disease trajectory often results in referral to palliative care in only the terminal, or ‘end of life’ phase. Yet, late engagement with palliative care can result in increased hospitalisations, length of stays, depression [
      • Rao A.
      • Zecchin R.
      • Newton P.J.
      • Phillips J.L.
      • DiGiacomo M.
      • Denniss A.R.
      • Hickman L.D.
      The prevalence and impact of depression and anxiety in cardiac rehabilitation: a longitudinal cohort study.
      ], poor symptom management, and decreased quality of life, and most importantly, fewer days for patients and family members in their preferred place of care before they die [
      • Atherton J.J.
      • Sindone A.
      • De Pasquale C.G.
      • Driscoll A.
      • MacDonald P.S.
      • Hopper I.
      • et al.
      National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018.
      ,
      • Kavalieratos D.
      • Gelfman L.P.
      • Tycon L.E.
      • Riegel B.
      • Bekelman D.B.
      • Ikejani D.Z.
      • et al.
      Palliative care in heart failure: rationale, evidence, and future priorities.
      ,
      • Liu A.Y.
      • O’Riordan D.L.
      • Marks A.K.
      • Bischoff K.E.
      • Pantilat S.Z.
      A comparison of hospitalized patients with heart failure and cancer referred to palliative care.
      ].
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