Heart Failure and Cardiomyopathies

A914JACC April 1, 2014

Volume 63, Issue 12

attitudeS and perceptionS regarding a generaliSt pluS SpecialiSt Model of palliative care in heart failure

Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.

Session Title: Approaches to Advanced Heart Failure: From VAD, Transplant, Palliative Care to New Perctutaneous TherapiesAbstract Category: 12. Heart Failure and Cardiomyopathies: ClinicalPresentation Number: 1221-201

Authors: Dio Kavalieratos, University of Pittsburgh, Pittsburgh, PA, USA

background: Heart failure (HF) is a chronic, prevalent, and progressive disease known for its severe insults to quality of life. Patients with HF possess significant physical and psychosocial needs, many of which are potentially amenable to palliative care (PC) interventions. Despite renewed attention in the 2013 ACA/AHA HF management guidelines on PC integration across the HF trajectory, PC utilization by patients with HF is suboptimal. We sought to explore provider perceptions regarding potential barriers impeding PC integration in HF management.

Methods: We conducted semi-structured qualitative interviews with healthcare providers often involved in the care of patients with HF. Key interview domains included: (1) hypothetical treatment strategy for an advanced HF patient with significant palliative needs; (2) knowledge, attitudes, and preferences regarding PC in HF; (3) knowledge, attitudes, and experiences with specialty PC; and, (4) barriers to PC utilization. Two analysts independently coded data using qualitative techniques.

results: We interviewed 18 providers from 3 clinical specialties: cardiology, primary care, and palliative medicine. Within each specialty, we sampled 4 physician and 2 mid-level providers, from a variety of practice settings. Findings overall highlight the problem poor coordination between cardiology and specialty PC. Reasons identified for this include: misperceptions of PC as a service strictly reserved for those at the end of life (i.e., hospice); perceptions of specialty PC referral as an act of “giving up” or patient abandonment; and, provider-perceived ambiguity between standard HF management and palliative practices.

conclusion: We identified several cognitive, educational, and organizational barriers, which participants believed influence PC integration in HF care. Additional research is needed to identify strategies to eliminate PC barriers for patients with HF, both generalist and specialist PC. Our work underscores the imperative for rigorous lay and professional education to increase PC awareness, to define palliative “best practices” in cardiology, and to dissociate PC from the notion of “comfort” or end-of-life care.