AHA Makes Case for Palliative Care in Advanced Cardiovascular Disease and Stroke

Healthcare professionals caring for patients with advanced cardiovascular disease and stroke should start implementing palliative care services early in the disease process, according to an American Heart Association/American Stroke Association policy statement. The authors make more than two dozen recommendations for how to boost the availability of palliative care in these high-risk patients.

“Typically, palliative care is spoken about in the cancer arena and it’s often equated with end-of-life care,” Lynne Braun, PhD (Rush University, Chicago, IL), chair of the writing committee, told TCTMD. “Yet the resources available and the expertise available from knowledgeable palliative care health professionals, or even the primary care team with knowledge of what is offered in palliative care, can really help meet the needs of individuals with advanced cardiovascular disease and stroke.”

Palliative care can address a variety of needs of patients and their families before the end of life and has been shown to improve the quality and length of life in certain patients, Braun added.

“Palliative care focuses on communication across the entire healthcare team to be sure that everybody is on the same page,” she said. “There’s shared decision-making between the patient and the family and the care team that needs to occur, and that is something that should occur early on. . . . It’s really important to be sure that the care team really understands what the patient’s needs and desires and values are.”

Overcoming Barriers to Palliative Care

In the statement published August 8, 2016, ahead of print in Circulation, the authors point out that there are barriers to patients receiving palliative care, including a reluctance on the part of healthcare providers to refer patients because they are not aware of available services or of the potential benefits. Physician discomfort with broaching the subject and reimbursement issues also contribute, they say.

“Congress has introduced legislation related to palliative care in the following areas: advance care planning and 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,” they note. “Recent changes by Medicare to pay for advance care planning services may help to make progress in reducing these barriers.”

The writing group makes 28 recommendations to guide policy decisions that may facilitate use of palliative care services. They focus on:

• Reimbursement for provision of palliative care services across disciplines
• Strengthening of payer-provider relationships to identify patients who need palliative care and to establish quality standards and measurement of outcomes
• Healthcare system policies to guide provision of palliative care services during hospitalization and during the transition to other care settings
• Healthcare provider education in palliative care and specialty certification

The authors also highlight the need for further research on the use of palliative care in patients with cardiovascular disease.

“Gaps in knowledge must be addressed about optimal palliative care for patients with CVD, long-term outcomes associated with early and iterative use of palliative care in CVD, and effectiveness of primary palliative care for patients with CVD,” they write.