Heart failure is a chronic condition where a person’s heart muscle is not able to pump enough blood to meet the needs of the body. While there are treatment options available, heart failure is a progressive condition that typically gets worse over time. Current guidelines recommend that patients with advanced heart failure receive palliative care as part of their coordinated care. However, it is rare for palliative care to be available to patients with heart failure in an ambulatory, outpatient setting.

Michael Beasley, MD, assistant professor of medicine (cardiovascular medicine), and Nora Segar, MD, assistant clinical professor (general internal medicine) and director of palliative medicine at the Saint Raphael Campus of Yale New Haven Hospital, recently established a new outpatient clinic to provide dedicated palliative care for people with end-stage heart failure.

“For many patients with advanced heart failure, hospice care does not meet their needs until very late in their course,” said Segar, an early champion of the clinic. “Instead, by providing early palliative care outside of the hospital, when it’s not a time of crisis, we can help patients accept and cope with their prognosis, manage their symptoms, and continue making plans for the future.”

New patients receive longer appointments, which allows the team to hear their stories and start building relationships with them.

“This extra time is essential because our team often engages in difficult conversations with our patients and manages complex, serious illnesses and medication plans,” said Beasley. “The extra time also gives patients and families time to process their emotions around these difficult decisions.”

The clinic's multidisciplinary care team helps patients address a variety of symptoms, from shortness of breath and gastrointestinal symptoms to depression and anxiety. The new clinic also cares for people with other cardiovascular diagnoses, like severe aortic stenosis or severe pulmonary hypertension, who could benefit from additional support outside the more traditional care pathways.

“Sometimes when patients come to us, they think there is nothing more a cardiologist like me can do for them,” says Beasley. “But by providing better symptom management and support, we can help them have a more comfortable life, often for quite some time.”

In addition to managing symptoms, the clinic supports patients with advanced care planning by helping them determine if they need a health care proxy, ensuring all their documentation is up-to-date, and helping them think about end-of-life wishes. If appropriate, the clinic’s team also refers patients to hospice and supports the transfer of care.

The clinic also includes Waleska Ortiz-Ayala, APRN, who is a palliative care advanced practice provider, as well as clinical social workers who can help connect patients with transportation, home health support, and other resources. In addition, the clinic regularly works with a palliative care chaplain to help patients handle existential questions and provide additional support.

The clinic will offer fellows in Yale's advanced heart failure and transplantation fellowship program the chance to rotate through its services. This experience will help them become more familiar with palliative care so they can incorporate those principles into their heart failure care practices.

While the clinic has only been open for less than a year, patients have had an overwhelmingly positive response.

“Our patients tell us that they are grateful to have our team support, as it is helpful for them to have difficult conversations in a compassionate environment,” said Ortiz-Ayala. “Our goal is to provide each person with holistic care that provides them with dignity and a higher quality of life; then they can focus on what matters most to them in the time they have left.”

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