Palliative care and chronic heart failure

Congestive heart failure is a serious and ultimately fatal illness, and there is currently no cure except for cardiac transplantation. Congestive heart failure (CHF) is a leading cause of morbidity and mortality. It is associated with marked impairments in health related quality of life, emotional and physical wellbeing. It is a leading cause of admission to acute care hospitals and subsequent readmission. Despite the high prevalence and high physical and psychosocial burden patients with CHF are underserved by palliative care and hospice programs. In this chapter we will describe the pathophysiological processes that underlie the functional complications of congestive heart failure, describe the natural history of congestive heart failure, the modes of demise of patients with CHF, its major subcategories: diastolic and systolic dysfunction. We will make recommendations for appropriate timing of referral to palliative care and hospice and describe the potential benefits for the inclusion of palliative care teams in the provision of care to patients with CHF and their families.