Heart failure is a pervasive and challenging condition affecting millions of people worldwide, with an estimate of 6.2 million people living with heart failure in the United States. While medical advancements have improved the management of this condition, there remains a critical need to enhance the quality of life for individuals living with heart failure. One promising avenue for achieving this goal is the integration of palliative care services into the care continuum.
In response to this opportunity to improve care for people with heart failure, C-TAC, and the American Heart Association (AHA) collaborated to launch the project Improving Quality of Life for People with Heart Failure through Integration of Palliative Care Services Initiative (PCHF) in January of this year. This project has four major goals:
- Recommend eligibility criteria for heart failure patients’ referral to palliative care services
- Develop a standardized palliative care referral pathway for eligible heart failure patients
- Produce educational materials for enrollment, including outreach materials
- Contribute to building the body of evidence of the benefits of integrating palliative care services into cardiology services for people with heart failure
A central aspect of this project is the development of eligibility and referral criteria for heart failure patients, ensuring that they receive timely access to palliative care services. This project is also focused on integrating updated clinical guidelines and best practices for palliative care into current clinical workflows across health systems and health plans.
National Clinical Advisory Council
C-TAC and the AHA have engaged clinical experts in integrating palliative care into care for people with heart failure by establishing a National Clinical Advisory Council, including:
- Larry Allen, MD, MHS Professor of Medicine, Kenneth Poirier Endowed Chair; Interim Head for Cardiology; Medical Director, Advanced Heart Failure; University of Colorado, School of Medicine
- Gwen Bernacki, MD, MHSA Cambia Palliative Care Center of Excellence, Core Member; Geriatric Research, Education, and Clinical Centers Patient Priorities Care Project Analyst; Assistant Professor, Department of Medicine, University of Washington; Veterans Administration of Puget Sound, Cardiology Division
- Caroline Doherty, DNP, AGACNP, BC, FACC Advanced Senior Lecturer, Biobehavioral Health Sciences; University of Pennsylvania
- Laura Gelfman, MD Associate Professor; Deputy Director of Quality and Clinical Information; Department of Geriatrics and Palliative Medicine; Icahn School of Medicine at Mount Sinai; Brookdale Department of Geriatrics and Palliative Medicine; Icahn School of Medicine at Mount Sinai; James J. Peters VA Medical Center
- Nathan Goldstein, MD Professor, Gerald J. and Dorothy R. Friedman Chair in Palliative Care; Vice-Chair for Professional Development, Brookdale Department of Geriatrics and Palliative Medicine; Site-Chair, Department of Geriatrics and Palliative Care, Mount Sinai Downtown
- Michelle Kittleson, MD, PhD Professor of Medicine; Director of Post Graduate Medical Education in Heart Failure and Transplantation; Director of Heart Failure Research; Cedars Sinai Medical Center
- Modele O. Ogunniyi, MD, MPH, FACC, FACP, FAHA Associate Professor of Medicine, Emory University School of Medicine; Cardiologist, Grady Health System
State Pilots
In addition to the leading clinical experts in the fields, representatives from four states are participating in the planning and implementation portions of this initiative: Alabama, California, Hawaii, and Louisiana. The project engages health plans, health systems, and state coalitions with a shared goal of enhancing the quality of life for individuals with serious illnesses. Participants include leading health systems delivering care to heart failure patients across the country, including:
Alabama
- Health System: University of Alabama, Birmingham
- Health Plan: Blue Cross Blue Shield Alabama
- Coalition Partner: Alabama State Advisory Council on Palliative Care and Quality of Life
California
- Health System: Cedars-Sinai Health System
- Health Plans: Blue Shield of California and HealthNet of California (Centene)
- Coalition Partner: California Coalition for Compassionate Care
Hawaii
- Health System: Hawaii Pacific Health
- Health Plan: Hawaii Medical Services Association
- Coalition Partner: Kokua Mau
Louisiana
- Health System: Ochsner Health System
- Health Plan: Humana
- Coalition Partner: Louisiana Healthcare Quality Forum
The PCHF project has made significant progress to date. The first phase of the project worked to develop a referral pathway for people with heart failure to access palliative care consultations. This included identifying health systems, payors, clinical subject matter experts, and community coalitions to provide representation and input on the referral pathway being developed.
Phase 2 focused on achieving consensus on eligibility criteria and developing the referral pathway. Workshops with participating teams from health systems have been instrumental in achieving the project’s goals, and participating health systems and health plan partners have found the criteria being developing feasible to implement. These workshops included recommending eligibility criteria for heart failure patients, developing a standardized referral pathway, creating educational and messaging materials, and setting up quality improvement projects that can be used to begin implementing the referral pathway prior to a larger evaluation of the guidelines.
The PCHF project initiative will report its findings about testing the eligibility criteria and referral pathway at the C-TAC-CAPC Leadership Summit in October 2023. Project sites will share data on the structure and process of their pilots, offering insights into the impact of these tools. The project’s National Clinical Advisory Council has provided valuable input to align the referral pathway being tested with the most up-to-date clinical evidence. Moving forward, C-TAC and AHA are seeking additional funding to evaluate the referral pathway on patient and provider experience of care across all participating sites. This phase aims to ensure we have enough people with heart failure receiving palliative care consultations to test the validity of criteria and messaging and assess the benefits of clinical cross-training for healthcare providers.
This project is a crucial step towards improving the quality of life for individuals with heart failure. It represents a collaborative effort to integrate palliative care into heart failure management, providing holistic support to patients and their families. As the project continues to evolve, it holds the potential to shape the future of heart failure care, making it more patient-centered and effective, and establishing standards and guidelines that can serve to ensure that people with heart failure can experience a high quality of life.
Interested in sponsoring the PCHF program, contact Joy Braun, VP of Development at jbraun@thectac.org.
