End-of-life care in advanced heart failure during cardiology training in India: A survey

Background: The incidence of heart failure (HF) is likely to increase in future in India. As a result, India's health-care system has to care for an increased number of patients with advanced HF (AHF) in future. The objectives of this survey were as follows: (a) to assess cardiology trainees' approach toward treating HF patients and end-of-life (EOL) care, and (b) to review cardiology training curricula and HF management guidelines regarding the approach to EOL care issues in AHF. Methods: We surveyed cardiology fellows undergoing training. The survey questions aimed to assess cardiology fellows' approach in treating patients with different severities of HF and at EOL. We reviewed the cardiology training curricula of various Indian institutions and HF management guidelines from Indian professional bodies. Results: Ninety-nine fellows took part in the survey. 93%–100% reported that they were likely to prescribe recommended drug therapy and Cardiac resynchronization therapy-D implantation to all the patients. The number of likely responses for various EOL interventions was consistently lower when fellows had to rate interventions for themselves as patients. Sixty-four percent of fellows were unfamiliar or uncertain about the idea of hospice care. Eighty-four percent of fellows reported that their training was inadequate, or they were uncertain about the adequacy of their training regarding EOL care issues. None of the training curricula has mentioned “EOL care,” “palliative care,” or “hospice care,” and none of the HF management guidelines discussed such topics. Conclusion: There is an urgent need for sensitizing and training Indian cardiology fellows regarding different aspects of AHF and EOL care.