What is Quality End-of-Life Care for Patients With Heart Failure? A Qualitative Study With Physicians

Document Type


Publication Date



Cardiology, MaineHealth Institute for Research

Journal Title

Journal of the American Heart Association

MeSH Headings

Adult; Aged; Cardiologists (psychology); Female; Heart Failure (therapy); Humans; Interviews as Topic; Male; Middle Aged; Physicians (psychology); Physicians, Primary Care (psychology); Qualitative Research; Quality of Health Care; Terminal Care (methods, standards)


Background Advanced heart failure (AHF) carries a morbidity and mortality that are similar or worse than many advanced cancers. Despite this, there are no accepted quality metrics for end-of-life (EOL) care for patients with AHF. Methods and Results As a first step toward identifying quality measures, we performed a qualitative study with 23 physicians who care for patients with AHF. Individual, in-depth, semistructured interviews explored physicians' perceptions of characteristics of high-quality EOL care and the barriers encountered. Interviews were analyzed using software-assisted line-by-line coding in order to identify emergent themes. Although some elements and barriers of high-quality EOL care for AHF were similar to those described for other diseases, we identified several unique features. We found a competing desire to avoid overly aggressive care at EOL alongside a need to ensure that life-prolonging interventions were exhausted. We also identified several barriers related to identifying EOL including greater prognostic uncertainty, inadequate recognition of AHF as a terminal disease and dependence of symptom control on disease-modifying therapies. Conclusions Our findings support quality metrics that prioritize receipt of goal-concordant care over utilization measures as well as a need for more inclusive payment models that appropriately reflect the dual nature of many AHF therapies.

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