Heart failure and a palliative approach: Getting the timing right

Heart failure (HF) is a frequently encountered illness in primary care settings with a one-year mortality rate of up to 75%. HF management appears to focus on maximizing heart function rather than on quality of life. Recently, the Canadian Hospice Palliative Care Association proposed the utilization of an integrated palliative approach when caring for patients with chronic life-limiting conditions. A palliative approach applies the principles of palliative care earlier in the course of a life-limiting disease, whenever there are unmet needs. The purpose of this project was to answer the question, “How can the Family Nurse Practitioner (FNP) apply a palliative approach in the care of individuals living with heart failure”? An analysis of the literature revealed that symptom burden and communication were significant areas of concern. Through the application of a palliative approach to these key areas, the FNP can positively influence the quality of living and dying for HF patients. Implications for FNP clinical practice, research and education are also identified and include the development of a comprehensive assessment tool for HF symptoms, early initiation of advanced care planning, and greater research and education regarding the effectiveness of a palliative approach.