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American Journal of Hospice and Palliative Medicine®, Vol. 22, No. 3, 211-222 (2005)
DOI: 10.1177/104990910502200311
© 2005 SAGE Publications

Palliation of heart failure

Mellar P. Davis, MD, FCCP

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Nancy M. Albert, PhD, MSN, RN

Division of Nursing, George M. and Linda Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio

James B. Young, MD

Division of Medicine, George and Linda Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio

Heart failure is the major cause of morbidity and mortality in the United States. Stage D heart failure has a greater mortality rate than many cancers and has equivalent symptom burden and severity. There has been a paradigm shift in our understanding of the pathophysiology of heart failure. Progressive heart failure is associated with ventricular remodeling and a maladaptive neurohumoral response. Drug classes have evolved that curtail ventricular remodeling, and blunt neurohumoral responses reduce morbidity and mortality. Despite combination drug and device therapies, the management of Stage D heart failure includes palliation. Both cardiology and palliative specialists need to learn from one another in order to palliate these highly symptomatic patients. Such collaboration will enhance care and are the basis for well-conceived research trials.

Key Words: systolic heart failure • angiotensin • converting enzymes • palliation


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