AHA, ASA release policy statement on palliative care for cardiovascular disease, stroke

Patients with advanced cardiovascular disease and stroke should receive palliative care early in their recovery process, according to a policy statement the American Heart Association (AHA) and American Stroke Association (ASA).

The statement, which was published online in Circulation on Aug. 8, focused on patients with heart failure and stroke. However, the writing committee mentioned that palliative care was helpful for patients with other cardiovascular conditions such as those with chronic angina and those at an advanced age who have multiple comorbidities.

The AHA and ASA defined palliative care as “patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing and treating suffering.” With palliative care, physicians and the care team listen to and collaborate with patients and their families when making treatment decisions, help them with advance care planning and pay attention to physical, emotional, spiritual and psychological distress.

Lead researcher Lynne T. Braun, PhD, CNP, FAHA, of Rush University Medical Center in Chicago, and her colleagues mentioned that healthcare providers often used palliative care when treating patients with heart failure. However, they added that palliative care was less common before and after patients undergo heart transplantation and varied in stroke patients depending on the extensiveness of the stroke and their stage after stroke.

Approximately 5.7 million adults in the U.S. have heart failure, while approximately 6.6 million Americans have had a stroke, according to the researchers.

The researchers mentioned a few reasons why patients are not always referred to palliative care. Healthcare providers may have a lack of knowledge about the benefits or availability of palliative care services or may not feel comfortable discussing palliative care with patients and their families. Palliative care is not always covered by insurance, too. However, they noted that Congress introduced legislation related to palliative care in advance care planning, advance directives, consumer and family caregiver education and support, professional education and workforce development, payment reform and quality measurement and reform of the Medicare hospice benefit.

“Palliative care provides that much-needed level of support for patients and families dealing with cardiovascular disease and stroke,” Braun said in a news release. “This approach to care can help patients better understand the disease they are fighting, their treatment options and their prognosis. More than that, it can give them the strength they need to carry on in their day-to-day life by easing the burden of care for the family, as well as providing extra relief from symptoms, distress and pain the patient may be experiencing.”

Although the AHA and ASA said palliative care is relevant throughout a person’s life, they cited data that showed 94 percent of the 20 million people who need palliative care at the end of life are adults.

The AHA and ASA also provided policy recommendations to states and federal agencies. For instance, they suggested that the Centers for Medicare & Medicaid Services (CMS) expand reimbursement for advance care planning and encourage decisions made in advance care planning discussions to be documented in a person’s medical record. They also recommended giving healthcare providers financial incentives to address the palliative needs of their patients. Further, they encouraged state Medicaid agencies to integrate palliative care into long-term services and adopt codes and reimbursement for providers to have advance care planning with patients.

In addition, they recommended that payers and providers share more data to help identify patients who need palliative care. They also suggested that there be more training and education on palliative care to increase the number of providers who can offer palliative care.

“Palliative care is an essential health benefit for every chronically ill patient, regardless of his or her background or age,” AHA CEO Nancy Brown said in a news release. “We hope these policy recommendations are adopted as soon as possible so more heart disease and stroke patients and their families can receive the palliative care they want and deserve.”