Abstract

Introduction: An estimated 26 million people worldwide suffer from the heart failure, and more than half of new diagnosis is made in those aged 80 years and above. Furthermore, nearly 75% have at least one other comorbidity. Advanced heart failure, defined as ‘advanced and persistent heart failure with symptoms at rest despite repeat attempts to optimize pharmacological and non-pharmacological therapy carry with it further problems including repeated hospitalizations, poor quality of life, disability and symptom burden, as well as reliance on intravenous support or device therapy, all of which have direct implications to both patients and their loved ones.

Objective: We explore the possible barriers that exist in initiating palliation in advanced heart failure patients, unique to an Asian and Malaysian population.

Discussion: We first explore the universal barriers towards palliation, including those revolving around limited evidence specifically surrounding heart failure palliation, communication breakdown, and accessibility and service provision limitation. We then explore specific barriers unique to Malaysia, surrounding its core value of being a multicultural, multi-faith nation.

Conclusion: Discussions surrounding heart failure palliation and palliative care remains taboo amongst patients and physicians. Heart failure remains an enigma and is often unpredictable in its course which leads to physician reluctance in discussing poor outcomes with patients. By understanding the barriers that exist, including that of culture and religion, we now know that early discussions and continuous involvement of both patients and their relatives in decision making may be the key in end-of-life care in advanced heart failure.

Keywords: Heart failure; Palliative medicine; Advanced heart failure; Socio-economic