Dying from heart failure: lessons from palliative care

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Many patients would benefit from palliative care at the end of their lives

Louise M E Gibbs, Locum consultant in palliative medicine,
Julia Addington-Hall, Senior lecturer in palliative care.,
J Simon R Gibbs (SimonGibbs@compuserve.com), Senior lecturer in cardiology

Royal Marsden Hospital, Sutton, Surrey SM2 5PT
Department of Palliative Care and Policy, Guy's, King's, and St Thomas's School of Medicine, London SE5 9PJ
National Heart and Lung Institute, Charing Cross Hospital, London W6 8RF

Increasing interest and research into the care of the dying over the past 25 years have resulted in better symptom control, psychological support, and choice for people dying from cancer and their families.1 Little attention has been paid, however, to patients with other life threatening diseases, such as AIDS, neurological conditions, respiratory failure, and heart failure. Palliative care, with its emphasis on the care of patients whose prognosis is limited, on quality (not quantity) of life, and on a multidisciplinary approach, may benefit patients other than those with cancer. One such group is patients dying from heart failure.

Heart failure is the only major cardiovascular disease with increasing prevalence, incidence, and mortality. Incidence and prevalence both increase dramatically over the age of 75 years—up to 43.5 and 190 per 1000 population respectively.2 With age adjusted mortality from cardiovascular …