Uncertainties of the heart: palliative care and adult heart failure.

Chronic heart failure (HF) is a growing public health concern in Western nations. Incidence of HF increases with age, and demographics in the United States support a growing HF population. Annually, more than 100,000 people are admitted to hospitals because of HF. Patients with chronic HF experience a highly morbid and life-limiting illness while suffering from substantial physical and psychosocial burdens. What is the state of the science regarding the use of palliative care for community-dwelling adult patients with HF? A review of the scientific literature was conducted using the key words "palliative care" and "heart failure" in several electronic databases (CINAHL, Medline, Proquest) from October 15 to November 15, 2011. Eleven of the 16 articles found indicated that palliative care is underused by HF patients. There is a large unmet care need for adults with chronic HF and their family caregivers. Home healthcare professionals develop and maintain relationships with community-dwelling patients with chronic HF over the course of their HF illness trajectory. Home healthcare professionals are in a unique position to identify HF patients who may benefit from palliative care programs delivered across care settings in the community. By developing ongoing relationships with patients and their family caregivers, we are able to focus on the complete care needs of this patient population and assist them with advanced care planning, psychological and social issues, and symptom management. We can also improve communication among care providers and patients/families to identify goals of care along the trajectory of HF illness.