Top Things to Know: Palliative and End-of-Life Care During Critical Cardiovascular Illness
Published: May 15, 2025
Prepared by Paul St. Laurent, DNP, RN, Vice President, Science & Medicine, American Heart Association
- Palliative care (PC) focuses on relieving suffering and aligning medical care with the values, goals, and preferences of patients and their families.
- Despite technological advances, conditions such as advanced heart failure and end-stage coronary artery disease continue to result in high morbidity and mortality.
- The aging population and increasing clinical complexity of patients underscore the growing need for PC integration in the cardiac intensive care unit (CICU).
- This statement outlines the role of PC across a range of cardiovascular (CV) conditions, including advanced heart failure, refractory arrhythmias, end-stage coronary artery disease, valvular disease, adult congenital heart disease, cerebrovascular disease, peripheral artery disease, and post-cardiac arrest care.
- PC is an interdisciplinary, patient- and family-centered approach aimed at optimizing quality of life and addressing physical, emotional, psychosocial, and spiritual needs.
- PC can be initiated at any stage of serious illness and delivered alongside disease-directed therapies.
- Early integration of PC into CV care promotes comprehensive management, including systematic assessment of symptoms, goals-of-care discussions, and advance care planning.
- Ethical considerations in end-of-life care include decisions regarding the withdrawal of life-sustaining therapies, deactivation of cardiac devices, and the use of palliative sedation to relieve intractable suffering.
- Despite its benefits, PC remains underutilized in the CICU, limiting its potential to improve patient and caregiver outcomes.
- Most residency and cardiology fellowship programs offer limited formal training in PC, highlighting the need for standardized education to prepare clinicians to meet the complex needs of critically ill CV patients.
Citation
Bohula EA, Landzberg MJ, Menon V, Alviar CL, Barsness GW, Crousillat D, Jain N, Page R 2nd, Wells R, Damluji AA; on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing. Palliative and end-of-life care during critical cardiovascular illness: a scientific statement from the American Heart Association. Circulation. Published online May 15, 2025. doi: 10.1161/CIR.0000000000001334