Improving Primary and Specialist Palliative Care in Cardiovascular Disease

Palliative care (PC) focuses on improving quality of life for people with severe illness of any age. Palliative care can be provided by a multidisciplinary team of PC specialists or by other health care professionals as primary or basic PC. Palliative care can be provided concurrent with life-prolonging or curative care as needed from time of diagnosis. In contrast, hospice (as defined in the United States) is a form of PC focused on providing comfort to people with an estimated prognosis of 6 months or less. Two 2017 systematic reviews 1,2 present early evidence of the benefit of PC in cardiovascular disease (CVD), particularly for patients with heart failure. Warraich et al 3 conducted a retrospective study using a PC registry to understand changes in characteristics and trends among 1801 patients with CVD referred to PC specialists during a 3-year period, from 2015 through 2017. The main question was whether patients with CVD were seen earlier in the disease trajectory over time, measured using the palliative performance score, a health care professional–rated measure of functional status. Warraich et al 3 found that 28.9% of patients (521 of 1801) had low palliative performance scores, consistent with being bedbound and requiring total care. This percentage did not change through time. Patients reported moderate to severe symptoms, includingpoorwell-being,tiredness,anorexia,dyspnea,andpain.Thestudyidentifiedsomechanges from 2015 to 2017, including a reduced proportion of black patients (11.9% in 2015 vs 6.3% in 2017), an increased proportion of coronary artery disease and valvular heart disease diagnoses (25.6% in 2015 vs 30.1% in 2017), and a reduced proportion of referrals from cardiologists (16.5% in 2015 vs 10.5% in 2017). This study offers insights on the emerging role of PC specialists in CVD. The characterization of functional status using the palliative performance score in such a large, multicenter population is unique, to my knowledge. Warraich et al 3 concluded that the data do not support that PC consultation Leveraging the skills of affiliate health care professionals (eg, nurses, social workers, chaplains) 5 and engaging patients and caregivers using technology are approaches to improve primary PC in CVD.