End-of-Life Considerations
CLASS I
(1) Ongoing patient and family education regarding prognosis for functional capacity and survival is recommended for patients with HF at the end of life.
(2) Patient and family education about options for formulating and implementing advance directives and the role of palliative and hospice care services with reevaluation for changing clinical status is recommended for patients with HF at the end of life.
(3) Discussion is recommended regarding the option of inactivating ICDs for patients with HF at the end of life.
(4) It is important to ensure continuity of medical care between inpatient and outpatient settings for patients with HF at the end of life.
(5) Components of hospice care that are appropriate to the relief of suffering, including opiates, are recommended and do not preclude the options for use of inotropes and intravenous diuretics for symptom palliation for patients with HF at the end of life.
(6) All professionals working with HF patients should examine current end-of-life processes and work toward improvement in approaches to palliation and end-of-life care.
CLASS III
(1) Aggressive procedures performed within the final days of life (including intubation and implantation of a cardioverter-defibrillator in patients with NYHA functional class IV symptoms who are not anticipated to experience clinical improvement from available treatments) are not appropriate.
JACC. 2009; 53; e1-e90