Palliative Cardiology in Clinical Practice

Patient education and shared decision-making are essential to align treatments with goals of care (GOC), particularly in cardiovascular disease patients who suffer high morbidity and mortality. The UT Southwestern Division of Cardiology is dedicated to advancing the field of palliative cardiology, an area that advocates for and promotes patient-centered care. At #AHA23, we had the opportunity to discuss these interests in two forums.

The Patient-Centered Approach to Cardiogenic Shock: Integration of Palliative and Critical Care

In an engaging session created by @CardioNerds for #AHA23, we served as cardio-palliative content experts. A case-based discussion prompted critical questions regarding how to ensure alignment of care with patients’ goals, particularly in high-stakes situations such as during activation of a shock team, and with clinicians from multiple disciplines. Key takeaways included the importance of: 1) Early goals of care discussions and 2) Communication training for clinicians and staff. The session brought national experts in cardiac critical care and cardiac palliative care together for a fruitful discussion that was both entertaining and informative, a signature of @CardioNerds events.

Reducing Health Care Disparities by Improving ICD Knowledge in a Diverse Population, A Quality Improvement Initiative to Align ICD Settings with Goals of Care

We also presented our work at #AHA23 aligning implantable cardioverter-defibrillators’ (ICDs’) shocks with patients’ GOC. It is well known that painful shocks occur in up to a third of ICD patients at end of life, preventing peaceful deaths and causing caregiver distress. In patients whose goals are improved quality rather than prolongation of life, we seek to align their ICD settings. This update builds upon our prior work showing gaps in patient ICD knowledge, which are largest in diverse, safety net populations. Commonly held patient misconceptions are that certain death ensues when shocks are turned off and that turning off shocks requires surgery. Thus, inadequate ICD understanding precludes the ability to have effective patient-clinician communication about shock settings. Therefore, we created a novel, seven-minute Parkland Health System ICD educational video narrated by patients and designed for our patient population. After showing the video with pre- and post-tests evaluating ICD knowledge and end-of-life preferences, we confirmed admitted patients with heart failure not only demonstrated a significant improvement in ICD knowledge but also a greater certainty in end-of-life preferences.

We believe this approach empowers patients with knowledge needed for important conversations about wishes for their lives and their deaths. While our video was created specifically for UT Southwestern and Parkland Health System patient populations, we were pleased to share it nationally, helping others educate patients and provide best practice, compassionate, patient-centered care.

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