End-of-Life Care in Heart Failure

End-of-Life Care in Heart Failure

INTRODUCTION

Erin K. Donaho, RN, BSN

Heart Failure Coordinator Texas Heart Institute @ St. Luke's Episcopal Hospital

Within the past 10 years heart failure deaths have increased nearly 21%. Although treatment advances have allowed patients to live longer with better quality of life, heart failure remains the leading cause of death ? even over all forms of cancer. Half of heart failure patients die within 5 years of diagnosis, and for many patients death occurs as a result of the debilitating progression of the disease. Recent years have brought about an increased awareness of the role of palliative care and an acknowledgement that patients with advanced heart failure have at least as great a need for supportive and palliative care as those with malignant disease. Palliative care focuses on relief of suffering, psychosocial support, and closure near the end of life; the concentration is on improved quality of life for how ever long life remains.

Although there is some overlap in services rendered through palliative care and hospice, it is important to understand that there remain distinct differences in the two systems of care. Palliative care is holistic interdisciplinary supportive care of patients whose disease is not responsive to curative treatment and includes the following: patient/ family education, aggressive symptom management, appropriate co-morbidity management, psychosocial assessment & treatment, social & financial assessment and referrals, and supportive care for patient and families throughout the illness (Consensus Statement: Palliative and Supportive Care in Advanced Heart Failure).

Hospice also provides comfort and support to patients whose illness no longer responds to curative treatment. However, hospice is a passive care process that seeks to improve the quality of the last days of life by offering comfort and dignity, with special emphasis on controlling pain and discomfort (Hospice Foundation of America).

The trajectory for heart failure, characterized by acute decompensation followed by periods of rebound functional status and relative stability, often causes uncertainty of prognosis for even the most experienced clinicians. It is important that practitioners discuss palliative care early in disease management, and implement effective palliative and end of life (EOL) strategies for advanced heart failure patients particularly when cardiac transplantation or assist-device implantation are not viable options.

CASE PRESENTATION

Background Information

? 50- year old African American male with refractory heart failure, progressive dyspnea and worsening fatigue despite aggressive heart failure management

? History of : - Non ischemic cardiomyopathy, hypertension, chronic atrial fibrillation, cerebrovascular disease s/p embolic CVA (residual cognitive deficits ? slow mentation), COPD, hyperlipidemia, DM type 2, iron deficiency anemia, hepatitis C - Recurrent right pleural effusions requiring multiple thoracentesis - ICD placed approximately one year prior - Echo with severe global hypokinesis, LVEF ................
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