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13. Goals of Care
13.1. Palliative and Supportive Care, Shared Decision-
Making, and End-of-Life
COR LOE
Recommendations
1 C-LD 1. For all patients with HF, palliative and supportive care—
including high-quality communication, conveyance of
prognosis, clarifying goals of care, shared decision-making,
symptom management, and caregiver support—should be
provided to improve QOL and relieve suffering.
1 C-LD 2. For patients with HF being considered for, or treated with,
life-extending therapies, the option for discontinuation
should be anticipated and discussed through the continuum
of care, including at the time of initiation, and reassessed with
changing medical conditions and shifting goals of care.
2a B-R 3. For patients with HF—particularly stage D HF patients
being evaluated for advanced therapies, patients requiring
inotropic support or temporary mechanical support,
patients experiencing uncontrolled symptoms, major
medical decisions, or multimorbidity, frailty, and cognitive
impairment—specialist palliative care consultation can be
useful to improve QOL and relieve suffering.
2a C-LD 4. For patients with HF, execution of advance care directives can
be useful to improve documentation of treatment preferences,
delivery of patient-centered care, and dying in preferred place.
2a C-LD 5. In patients with advanced HF with expected survival <6
months, timely referral to hospice can be useful to improve
QOL.
