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Commentary on primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial

      Heart failure affects more than 26 million people worldwide with over six million people just in the United States. Persons with heart failure suffer from burdensome symptoms, frequent hospitalizations, and often poor quality of life.
      • Khan F.R.
      • Feder S.
      • Goldsetin N.E.
      • Chaudhry S.I.
      Symptom burden among patients who were hospitalized for heart failure.
      • Kavalieratos D.
      • Kamal A.H.
      • Abernethy A.P.
      • et al.
      Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
      • Chaudhry S.I.
      • McAvay G.
      • Chen S.
      • et al.
      Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the Cardiovascular Health Study.
      Palliative care is person and family-focused care centered on improving quality of life through symptom management and the alignment of care goals with person and family preferences. For almost a decade, professional societies and clinical practice guidelines have called for the integration of palliative care into heart failure clinical management in recognition of this population's pressing palliative needs.
      • Yancy C.W.
      • Jessup M.
      • Bozkurt B.
      • et al.
      2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.
      • TM Maddox
      • JL Jr, Januzzi
      • et al.
      Writing Committee
      2021 Update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a Report of the American College of Cardiology Solution Set Oversight Committee.
      • Allen L.A.
      • Stevenson L.W.
      • Grady K.L.
      • et al.
      Decision making in advanced heart failure: a scientific statement from the American Heart Association.
      • Yancy C.W.
      • Jessup M.
      • Bozkurt B.
      • et al.
      2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.
      • Fang J.C.
      • Ewald G.A.
      • Allen L.A.
      • et al.
      Advanced (stage D) heart failure: a statement from the heart failure society of america guidelines committee.
      Yet access to palliative care for persons with heart failure remains woefully limited. Most persons with heart failure access palliative care services at tertiary or quaternary care centers leaving few options for persons in the community who cannot travel to these sites. Moreover, demand for palliative care services is outstripping supply, with too few palliative specialists able to care for an increasing volume of patients.
      • Kamal A.H.
      • Bull J.H.
      • Wolf S.P.
      • et al.
      Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S.
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