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Clinical Decisionmaking

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Experts focus on prognosis, symptom management, and supportive care for patients with advanced heart failure

Patients with advanced heart failure (HF) are commonly distressed by lack of energy, weakness or fatigue, pain, shortness of breath, insomnia, and depression, and they require specialized interventions to manage symptoms and prolong life. Management of HF patients often involves chronic outpatient care interspersed with hospitalization and aggressive rescue efforts.

A panel of experts in heart failure, palliative medicine, geriatrics, outcomes measurement, and health care improvement recently participated in a consensus conference that was supported in part by the Agency for Healthcare Research and Quality (HS13804). They discussed current knowledge and proposed further research on prognosis, symptom management, and supportive care for advanced heart failure patients.

Sarah J. Goodlin, M.D., of Intermountain Health Care in Salt Lake City, and other panel members reached several conclusions. First, although supportive care should be integrated throughout treatment of patients with advanced HF, data are needed to understand how to best decrease physical and psychosocial burdens of advanced HF to meet patient and family needs. Second, since determining a patient's prognosis in advanced HF is difficult, data are also needed to understand which patients will benefit from which interventions and how best to counsel patients.

Third, research is needed to identify which interventions improve quality of life and best achieve the outcomes desired by patients and family members. Fourth, care should be coordinated between sites of care. Fifth, physicians caring for patients with advanced HF should develop skills to better integrate the patient's preferences into the goals of care. A patient-centered, family-focused structure should frame the approach to care for advanced HF in light of the symptoms and burdens occurring throughout the illness. This approach offers more informed choices and support for patients and families and allocates scare medical resources most appropriately.

See "Consensus statement: Palliative and supportive care in advanced heart failure," by Dr. Goodlin, Paul J. Hauptman, M.D., Robert Arnold, M.D., and others, in the Journal of Cardiac Failure 10(3), pp. 200-209, 2004.

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