In a recent publication in Circulation: Cardiovascular Quality and Outcomes, the American Heart Association (AHA) published their scientific statement regarding the use of palliative pharmacotherapy for CVD to provide a resource for clinicians who care for patients with CVD as well as practical recommendations for employing palliative methods for medication management in clinical practice.

The AHA noted that applying patient-centered palliative care therapies, including prescribing, adjusting, or discontinuing medications per patient-centered interventions, may assist in controlling symptoms and enhancing health-related quality of life for patients with CVD.

The AHA noted in a recent press release, “The new scientific statement reviews current evidence on the benefits and risks of cardiovascular and essential palliative medications. The statement provides guidance for healthcare professionals to incorporate palliative methods as part of holistic medication management at all stages of a patient’s health conditions, emphasizing the importance of shared decision-making and goal-oriented care.”

The panel of experts indicated that patients need to be informed about their diagnosis and how pharmacological therapy may change during the course of treatment. The authors wrote, “Optimal effectiveness of palliative pharmacotherapy is attained when primary care clinicians, cardiovascular experts, and specialty-aligned palliative care (SAPC) teams collaborate to deliver patient-centered care.”

The new AHA statement also includes a summary of pharmacologic agents for controlling symptoms, improving survival, and preventing clinical events. This can be employed as a reference for clinicians engaging in shared decision-making to ascertain whether evidence-based treatments should be maintained or de-escalated in patients with end-stage CVD.

Additionally, deprescribing and de-escalating are critical components of palliative care, especially in patients with multiple chronic comorbidities. To optimize care, clinicians should routinely evaluate the risks, benefits, indications, and anticipated time to clinical benefit of each medication tailored to patient needs and adjust accordingly.

Other key highlights include: 1) palliative medication management emphasizes providing symptom relief and enhancing the quality of life for patients with CVD throughout the various stages; 2) decisions about beginning, changing, or discontinuing cardiovascular and other medicines should be patient-centered and incorporate input from multiple specialties, including cardiology experts, working in conjunction with primary care professionals; and 3) evidence demonstrates that adding palliative care interventions to standard cardiovascular care enhances clinical outcomes for patients with CVD; however, recent clinical evidence indicates palliative care is underutilized, particularly in patients affected by social determinants of health and healthcare disparities.

Chair of the statement writing group Katherine E. Di Palo, PharmD, MBA, MS, FAHA, senior director of Transitional Care Excellence at Montefiore Medical Center and assistant professor of medicine at Albert Einstein College of Medicine in New York City, stated, “It is critical for patients to be fully informed about their diagnosis and how medication management may change throughout the disease progression so they have ample time to set and share their goals. These goals often include reducing symptoms such as shortness of breath, fatigue, and pain as well as improving sleep, mood, and appetite.”

“Palliative pharmacotherapy encompassing cardiovascular drugs and essential palliative medicines can be implemented across the clinical course of CVD to improve quality of life and decrease burden. Early warning signs of decompensation, such as refractory symptoms and increased healthcare use, should prompt clinicians to intensify palliative pharmacotherapy among individuals with ESCVD [end-stage CVD] and refer them to SAPC teams,” concluded the panel of experts. “The cardinal principles of goals of care and shared decision-making are foundational for a patient-centered approach to palliative prescribing and deprescribing,” they added.

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