Congestive heart failure end-of-life considerations: Difference between revisions

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(/* 2022 AHA/ACC/HFSA Guideline/ 2013 ACCF/AHA Guideline/2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) {{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice G...)
 
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{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}
{{CMG}} {{AE}} [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] [Mailto:efco@alum.up.edu.ph]


==Overview==
==Overview==
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Some have argued that any patient with NYHA class III CHF should have a palliative care referral.  Palliative care can not only provide symptom management, but also assist with advanced care planning, goals of care in the case of a significant decline, and making sure the patient has a medical [[power of attorney]] and discussed his or her wishes with this individual.
Some have argued that any patient with NYHA class III CHF should have a palliative care referral.  Palliative care can not only provide symptom management, but also assist with advanced care planning, goals of care in the case of a significant decline, and making sure the patient has a medical [[power of attorney]] and discussed his or her wishes with this individual.
== 2013 ACCF/AHA Guideline/2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>==
== 2022 AHA/ACC/HFSA Guideline/ 2013 ACCF/AHA Guideline/2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref> <ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016.[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>==




===Congestive heart failure end-of-life considerations (DO NOT EDIT)<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 |volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref> <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref><ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] ''Circulation'' 112 (12):e154-235.[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586] PMID: [http://pubmed.gov/16160202 16160202]</ref>===
===Palliative and Supportive Care, Shared Decision-Making, and End-of-Life (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID:[http://pubmed.gov/19324967 19324967]</ref>===
 


{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Ongoing patient and family education regarding prognosis for functional capacity and survival is recommended for patients with [[HF]] at the end of life. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''For all patients with HF, palliative and supportive care- including high-quality communication, conveyance of prognosis, clarifying goals of care, shared decision-making, symptom management, and caregiver support- should be provided to improve QOL and relieve suffering. <ref name="pmid31307276">{{cite journal| author=Datla S, Verberkt CA, Hoye A, Janssen DJA, Johnson MJ| title=Multi-disciplinary palliative care is effective in people with symptomatic heart failure: A systematic review and narrative synthesis. | journal=Palliat Med | year= 2019 | volume= 33 | issue= 8 | pages= 1003-1016 | pmid=31307276 | doi=10.1177/0269216319859148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31307276  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>


|-
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patient and family education about options for formulating and implementing advance directives and the role of [[palliative care|palliative]] and [[hospice care]] services with reevaluation for changing clinical status is recommended for patients with [[HF]] at the end of life. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For [[patients]] with [[HF]] being considered for, or treated with, [[life]]-extending therapies, the option for discontinuation should be anticipated and discussed through the continuum of [[care]], including at the time of initiation, and reassessed with changing [[medical]] conditions and shifting goals of [[care]].<ref name="pmid20194235">{{cite journal| author=Goldstein N, Carlson M, Livote E, Kutner JS| title=Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey. | journal=Ann Intern Med | year= 2010 | volume= 152 | issue= 5 | pages= 296-9 | pmid=20194235 | doi=10.7326/0003-4819-152-5-201003020-00007 | pmc=2832227 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20194235  }} </ref><ref name="pmid26998594">{{cite journal| author=McIlvennan CK, Jones J, Allen LA, Swetz KM, Nowels C, Matlock DD| title=Bereaved Caregiver Perspectives on the End-of-Life Experience of Patients With a Left Ventricular Assist Device. | journal=JAMA Intern Med | year= 2016 | volume= 176 | issue= 4 | pages= 534-9 | pmid=26998594 | doi=10.1001/jamainternmed.2015.8528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26998594  }} </ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>


|-
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Discussion is recommended regarding the option of inactivating [[ICD]]s for patients with [[HF]] at the end of life. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' It is important to ensure continuity of medical care between inpatient and outpatient settings for patients with [[HF]] at the end of life. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' Components of [[hospice care]] that are appropriate to the relief of suffering, including [[opiate]]s, are recommended and do not preclude the options for use of [[inotrope]]s and intravenous [[diuretic]]s for symptom [[palliation]] for patients with [[HF]] at the end of life. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>


{|class="wikitable" style="width:80%"
|-
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' All professionals working with [[HF]] patients should examine current end-of-life processes and work toward improvement in approaches to [[palliation]] and end-of-life care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' Palliative and supportive care is effective for patients with symptomatic advanced [[HF]] to improve quality of life.<ref name="pmid18195339">{{cite journal| author=Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA et al.| title=Evidence for improving palliative care at the end of life: a systematic review. | journal=Ann Intern Med | year= 2008 | volume= 148 | issue= 2 | pages= 147-59 | pmid=18195339 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18195339 }} </ref><ref name="pmid18195338">{{cite journal| author=Qaseem A, Snow V, Shekelle P, Casey DE, Cross JT, Owens DK et al.| title=Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice guideline from the American College of Physicians. | journal=Ann Intern Med | year= 2008 |volume= 148 | issue= 2 | pages= 141-6 | pmid=18195338 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18195338 }} </ref><ref name="pmid22392529">{{cite journal| author=Allen LA, Stevenson LW, Grady KL, Goldstein NE, Matlock DD, Arnold RM et al.| title=Decision making in advanced heart failure: a scientific statement from the American Heart Association. |journal=Circulation | year= 2012 | volume= 125 | issue= 15 | pages= 1928-52 | pmid=22392529 | doi=10.1161/CIR.0b013e31824f2173 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22392529 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3. '''For [[patients]] with [[HF]]- particularly stage D HF [[patients]] being evaluated for advanced [[therapies]], [[patients]] requiring [[inotropic]] support or temporary mechanical support, [[patients]] experiencing uncontrolled [[symptoms]], major [[medical]] decisions, or multi[[morbidity]], frailty, and [[cognitive impairment]] - specialist [[palliative care]] consultation can be useful to improve [[QOL]] and relieve [[suffering]]. <ref name="pmid28705314">{{cite journal| author=Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M | display-authors=etal| title=Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial. | journal=J Am Coll Cardiol | year= 2017 | volume= 70 | issue= 3 | pages= 331-341 | pmid=28705314 | doi=10.1016/j.jacc.2017.05.030 | pmc=5664956 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28705314 }} </ref><ref name="pmid29482218">{{cite journal| author=Bekelman DB, Allen LA, McBryde CF, Hattler B, Fairclough DL, Havranek EP | display-authors=etal| title=Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial. | journal=JAMA Intern Med | year= 2018 | volume= 178 | issue= 4 | pages= 511-519 | pmid=29482218 | doi=10.1001/jamainternmed.2017.8667 | pmc=5876807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29482218 }} </ref><ref name="pmid29641819">{{cite journal| author=O'Donnell AE, Schaefer KG, Stevenson LW, DeVoe K, Walsh K, Mehra MR | display-authors=etal| title=Social Worker-Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): A Pilot Randomized Clinical Trial. | journal=JAMA Cardiol | year= 2018 | volume= 3 | issue= 6 | pages= 516-519 | pmid=29641819 | doi=10.1001/jamacardio.2018.0589 | pmc=6128511 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29641819 }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki>
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{|class="wikitable" style="width:80%"
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|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4. '''For [[patients]] with [[HF]], execution of advance [[care]] directives can be useful to improve documentation of [[treatment]] preferences, delivery of [[patient]]-centered [[care]], and dying in preferred place.<ref name="pmid31720968">{{cite journal| author=Schichtel M, Wee B, Perera R, Onakpoya I| title=The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis. | journal=J Gen Intern Med | year= 2020 | volume= 35 | issue= 3 | pages= 874-884 | pmid=31720968 | doi=10.1007/s11606-019-05482-w | pmc=7080664 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31720968  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
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|bgcolor="LightCoral"| <nowiki>"</nowiki>'''1.''' Aggressive procedures performed within the final days of life (including [[intubation]] and implantation of a [[cardioverter-defibrillator]] in patients with NYHA functional class IV symptoms who are not anticipated to experience clinical improvement from available treatments) are not appropriate. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5. '''In [[patients]] with advanced [[HF]] with expected [[survival]] <6 months, timely referral to [[hospice]] can be useful to improve [[QOL]]. <ref name="pmid20846650">{{cite journal| author=Candy B, Holman A, Leurent B, Davis S, Jones L| title=Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence. | journal=Int J Nurs Stud | year= 2011 | volume= 48 | issue= 1 | pages= 121-33 | pmid=20846650 | doi=10.1016/j.ijnurstu.2010.08.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20846650  }} </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
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==External Links==
==External Links==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>
*[http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8807.full.pdf 2013 ACCF/AHA Guideline for the Management of Heart Failure]<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref>
*[http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8807.full.pdf 2013 ACCF/AHA Guideline for the Management of Heart Failure]<ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al.| title=2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume=  | issue=  | pages=  | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }} </ref>


Latest revision as of 14:04, 21 June 2022
Resident
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Congestive Heart Failure Microchapters

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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
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Congestive heart failure end-of-life considerations

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Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Risk calculators and risk factors for Congestive heart failure end-of-life considerations

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D. [2]

Overview

End of life care in the patient with congestive heart failure is focused on making the patient comfortable. Invasive procedures should be minimized, and patients may elect to have their defibrillators inactivated. The growing number of patients with Stage IV heart failure (intractable symptoms of fatigue, shortness of breath or chest pain at rest despite optimal medical therapy) should be considered for palliative care or hospice, according to American College of Cardiology/American Heart Association guidelines listed below.

Some have argued that any patient with NYHA class III CHF should have a palliative care referral. Palliative care can not only provide symptom management, but also assist with advanced care planning, goals of care in the case of a significant decline, and making sure the patient has a medical power of attorney and discussed his or her wishes with this individual.

2022 AHA/ACC/HFSA Guideline/ 2013 ACCF/AHA Guideline/2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Heart Failure in the Adult (DO NOT EDIT) [1] [2][3]

Palliative and Supportive Care, Shared Decision-Making, and End-of-Life (DO NOT EDIT) [1][2][3]

Class I
"1.For all patients with HF, palliative and supportive care- including high-quality communication, conveyance of prognosis, clarifying goals of care, shared decision-making, symptom management, and caregiver support- should be provided to improve QOL and relieve suffering. [4](Level of Evidence: C-LD) "
"2. For patients with HF being considered for, or treated with, life-extending therapies, the option for discontinuation should be anticipated and discussed through the continuum of care, including at the time of initiation, and reassessed with changing medical conditions and shifting goals of care.[5][6] (Level of Evidence: C-LD) "
Class IIa
"3. For patients with HF- particularly stage D HF patients being evaluated for advanced therapies, patients requiring inotropic support or temporary mechanical support, patients experiencing uncontrolled symptoms, major medical decisions, or multimorbidity, frailty, and cognitive impairment - specialist palliative care consultation can be useful to improve QOL and relieve suffering. [7][8][9](Level of Evidence: B-R) "
"4. For patients with HF, execution of advance care directives can be useful to improve documentation of treatment preferences, delivery of patient-centered care, and dying in preferred place.[10](Level of Evidence: C-LD) "
"5. In patients with advanced HF with expected survival <6 months, timely referral to hospice can be useful to improve QOL. [11](Level of Evidence: C-LD) "

Vote on and Suggest Revisions to the Current Guidelines

External Links

References

  1. ↑ 1.0 1.1 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE; et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  3. ↑ 3.0 3.1 3.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016.DOI:10.1161/CIRCULATIONAHA.109.192064 PMID:19324967
  4. ↑ Datla S, Verberkt CA, Hoye A, Janssen DJA, Johnson MJ (2019). "Multi-disciplinary palliative care is effective in people with symptomatic heart failure: A systematic review and narrative synthesis". Palliat Med. 33 (8): 1003–1016. doi:10.1177/0269216319859148. PMID 31307276.
  5. ↑ Goldstein N, Carlson M, Livote E, Kutner JS (2010). "Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey". Ann Intern Med. 152 (5): 296–9. doi:10.7326/0003-4819-152-5-201003020-00007. PMC 2832227. PMID 20194235.
  6. ↑ McIlvennan CK, Jones J, Allen LA, Swetz KM, Nowels C, Matlock DD (2016). "Bereaved Caregiver Perspectives on the End-of-Life Experience of Patients With a Left Ventricular Assist Device". JAMA Intern Med. 176 (4): 534–9. doi:10.1001/jamainternmed.2015.8528. PMID 26998594.
  7. ↑ Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M; et al. (2017). "Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial". J Am Coll Cardiol. 70 (3): 331–341. doi:10.1016/j.jacc.2017.05.030. PMC 5664956. PMID 28705314.
  8. ↑ Bekelman DB, Allen LA, McBryde CF, Hattler B, Fairclough DL, Havranek EP; et al. (2018). "Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial". JAMA Intern Med. 178 (4): 511–519. doi:10.1001/jamainternmed.2017.8667. PMC 5876807. PMID 29482218.
  9. ↑ O'Donnell AE, Schaefer KG, Stevenson LW, DeVoe K, Walsh K, Mehra MR; et al. (2018). "Social Worker-Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): A Pilot Randomized Clinical Trial". JAMA Cardiol. 3 (6): 516–519. doi:10.1001/jamacardio.2018.0589. PMC 6128511. PMID 29641819.
  10. ↑ Schichtel M, Wee B, Perera R, Onakpoya I (2020). "The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis". J Gen Intern Med. 35 (3): 874–884. doi:10.1007/s11606-019-05482-w. PMC 7080664 Check |pmc= value (help). PMID 31720968.
  11. ↑ Candy B, Holman A, Leurent B, Davis S, Jones L (2011). "Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence". Int J Nurs Stud. 48 (1): 121–33. doi:10.1016/j.ijnurstu.2010.08.003. PMID 20846650.
  12. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
  13. ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 112 (12):e154-235. DOI:10.1161/CIRCULATIONAHA.105.167586 PMID: 16160202

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