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Dying from Cardiovascular Disease: An Epidemiologic Perspective

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End-of-Life Care in Cardiovascular Disease

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Abstract

While cardiovascular disease is widely recognized as a leading cause of death, end of life care for patients dying from cardiovascular disease remains incompletely embraced. Heart failure is a common final pathway for many such patients; its incidence is increasing as are the costs associated with it. A significant proportion of the costs associated with congestive heart failure are incurred in the last months of life, and may be related to overly aggressive care in patients with an irreversibly poor prognosis. Many factors contribute to the poor uptake of palliative and hospice care. Chief amongst these is the difficulty in establishing prognosis and predicting death among patients with cardiovascular disease. It has been suggested that novel models of palliation may be needed given these challenges.

In this chapter, we discuss the epidemiology of dying from heart disease, and highlight some of the expected benefits with palliative/hospice care while highlighting gaps in its provision and uptake. We provide an overview of practical, validated methods for predicting prognosis near end of life for patients with cardiovascular illness that are suitable for use at the bedside. We also provide practical guidance to facilitate use of clinical epidemiological principles for patient management and resource use near end of life is provided.

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Authors and Affiliations

  1. Department of Medicine, Toronto General Hospital, Toronto, ON, Canada

    Husam Abdel-Qadir MD

  2. Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada

    Adam Herman BSc

  3. Department of Medicine, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada

    Douglas S. Lee MD, PhD

  4. Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, NU 4-482 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada

    Douglas S. Lee MD, PhD

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  1. Husam Abdel-Qadir MD
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  2. Adam Herman BSc
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  3. Douglas S. Lee MD, PhD
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Correspondence to Douglas S. Lee MD, PhD .

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Editors and Affiliations

  1. Portland VA Medical Center,, Patient-Centered Education and Research, Salt Lake City, UT, USA, Portland, Oregon, USA

    Sarah J. Goodlin

  2. Washington University School of Medicine, St Louis, Missouri, USA

    Michael W. Rich

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Abdel-Qadir, H., Herman, A., Lee, D.S. (2015). Dying from Cardiovascular Disease: An Epidemiologic Perspective. In: Goodlin, S., Rich, M. (eds) End-of-Life Care in Cardiovascular Disease. Springer, London. https://doi.org/10.1007/978-1-4471-6521-7_1

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