The American Heart Association and American Stroke Association say that palliative care should be integrated into the care of all patients with advanced cardiovascular disease and stroke as a means to relieve symptoms, improve patients’ satisfaction with their care, reduce costs and extend survival (Circulation 2016;134: e198-225). Yet, according to 2015 data from the National Palliative Care Registry, only 13 percent of palliative care patients had a cardiac diagnosis. This finding signals the need for both increased referrals to palliative care and more training for cardiovascular specialists in core palliative care skills.
Early palliative care is best
Palliative care consultation should be considered for patients with cardiovascular disease or stroke whenever a clinician sees either the warning signs of suffering or unmet needs suggested by frequent visits to the emergency department, high symptom burden or caregiver stress, according to an analysis published by the American College of Cardiology (online February 16, 2016). Early palliative care is best and is appropriate at any age and stage of illness.
Advanced cardiovascular disease and stroke frequently impose long-term challenges on patients and their families. These conditions often are characterized by unpredictable decompensations and improvements, with subtle decline over time that result in many patients suffering with unrecognized symptoms and unmet needs. Patients often experience high symptom burden (including refractory angina, recurrent implantable cardioverter-defibrillator shocks and depression) and low quality of life. There is also avoidable utilization of healthcare services in this patient population, including emergency department visits and hospitalization.
Case for collaboration
There is enormous opportunity for collaboration and improvement. By increasing referrals to palliative care specialists as well as filling the gaps in most cardiologists’ (and indeed most clinicians’) core knowledge, communication skills and symptom management, palliative care can move from being an underused layer of support for cardiologists to an integral part of quality cardiology.
Palliative care then will become an effective means for improving quality of care while boosting value-based measures, including cost and resource utilization.
The Center to Advance Palliative Care, co-sponsor of the National Palliative Care Registry, is the nonprofit organization that provides healthcare organizations with tools, training and technical assistance for both palliative care specialists and non-palliative care specialists, such as cardiologists, who are seeking to expand their skills in symptom management and communication with patients facing serious illness.
When cardiologists and palliative care specialists work together, we can offer patients living with advanced cardiovascular disease and stroke, and their families, the benefits of both high-quality, disease-modifying treatment and good palliative care. Our ultimate goal is the same: to improve patients’ survival, symptoms and quality of life.
Andrew E. Esch, MD, MBA, is a palliative care specialist and medical education consultant to the Center to Advance Palliative Care.