End-of-life care in hospitalized patients with cardiovascular and cerebrovascular disease

Abstract

We sought to review and increase understanding of the last days of life of patients hospitalized with advanced heart failure and acute stroke, which are the paradigms of end-of-life care of patients with cardiovascular and cerebrovascular disease, in order to improve treatment and clinical decision-making. These patients constitute an increasing health care problem, entailing both high morbidity and mortality. In-hospital death rates for cardiovascular illnesses have decreased over several decades, although they vary by geographic region and health care resources. Cardiovascular disease is the primary cause of death world-wide. While in-hospital death from coronary artery and valvular heart disease is less common now than it was several decades ago, reduction in hospital and short-term post-hospital mortality are major quality initiatives. Comprehensive clinical evaluation is essential in order to identify factors that may influence prognosis (e.g., comorbid conditions, functional status, and frailty) so that best and early care programs can be administered. Palliative care is known to be relatively undeveloped in these groups of patients, and should be implemented and be part of the multidisciplinary approach. The aim in patients likely to die is to improve symptoms and quality of life, while avoiding the use of aggressive therapies that are known to consume health-care resources without providing significant benefit. Physicians should not only use palliative measures when the patient is close to death, but throughout care. Dying patients with cardiovascular or cerebrovascular disease have the right to be involved in the decision-making process. Consequently, they or a designated surrogate should be fully informed about their medical condition, eventual interventions and prognosis. This is essential so that the can express their opinion and wishes, including place of death and psycho-spiritual care.