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Managing futility in critically ill patients with cardiac disease

Nature Reviews Cardiology volume 10, pages 723–731 (2013)Cite this article

Subjects

Key Points

  • Numerous strategies exist to improve the care of patients with life-threatening conditions; however, these options are often denied to critically ill patients with cardiac diseases

  • Acknowledgement and understanding of the concept of futility in critically ill patients with cardiac disease paves the way for a patient-centred approach to end-of-life care and treatment

  • Patient autonomy is central to the delivery of high-quality care, demanding decision-making be shared between the physician, the patient, and their family to ensure patient preferences are acknowledged and respected

  • Shared decision-making, advance care decisions, timely referral for palliative care, and a realistic approach to the benefit of interventions should be standard for all patients with end-stage cardiac diseases

  • Research should focus on the patient experience, patient-reported outcomes of interventions in end-stage cardiac disease, and how established approaches for malignant disease can be adapted and deployed for cardiac patients

Abstract

Despite extraordinary innovations in cardiology and critical care, cardiovascular disease remains the leading cause of death globally, and heart failure has one of the highest disease burdens of any medical condition in the Western world. The lethality of many cardiac conditions, for which symptoms and prognoses are worse than for many malignancies, is widely under-recognized. A number of strategies have been developed within specialties such as oncology to improve the care of patients with life-threatening conditions. For reasons that are multifactorial, these options are often denied to critically ill patients with cardiac disease. Cardiologists and intensivists often regard death as failure, continuing to pursue active treatment while potentially denying patients access to alternatives such as symptom control and end-of-life care. Patient autonomy is central to the delivery of high-quality care, demanding shared decision-making to ensure patient preferences are acknowledged and respected. Although many cardiologists and intensivists do provide thoughtful and patient-centred care, the pressure to intervene can lead to physician-centric care focused around the needs and wishes of medical staff to the detriment of patients, families, health-care workers, and society as a whole.

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Figure 1: Schematic algorithm of shared treatment decision-making in intensive care.

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    Susanna Price & Elizabeth Haxby

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S. Price researched data for the article. S. Price and E. Haxby substantially contributed to discussion of content, wrote, and reviewed and edited the manuscript before submission.

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Price, S., Haxby, E. Managing futility in critically ill patients with cardiac disease. Nat Rev Cardiol 10, 723–731 (2013). https://doi.org/10.1038/nrcardio.2013.161

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