The last session of the Malmo Spring Meeting featured Mary Ryder and David Thompson to introduce the issues surrounding end of life care for cardiac patients.
Mary Ryder ANP RN NFESC: Providing Palliative Care in End-Stage HF
View slide It is difficult to predict exactly when the end of life is approaching for cardiac patients due to the trajectory of periods of relatively mild symptoms interjected with periods of decompensation necessitating intravenous medications and/or hospitalization. However, the patients need to understand the severity of their disease and be given the chance to plan and make decisions regarding their wishes for the end of their life. The ESC has defined the patient with advanced heart failure as continuing to experience symptoms despite optimized pharmacological and non-pharmacological treatment, and, has had at least one decompensation within a 6-month period, needs frequent/continual intravenous support and has a poor quality of life with symptoms on minimal exertion or at rest.
The cardiac patient experiences similar symptoms to patients dying of lung cancer and yet the specialist palliative care services available to patients with lung cancer are rarely offered to the cardiac patient. Heart failure teams would benefit from having advice or training in palliative methods to add these to the normal heart failure care.
David R. Thompson PhD RN FRCN FESC: Death and End of Life Issues in Cardiac Patients View slide Quality of life for cardiac patients at the end of their lives, and their families, is poor. The symptom burden is similar to that of cancer. Most patients and families lack the knowledge and understanding of their condition and prognosis and find their healthcare needs are poorly addressed. Provision, coordination, uptake and continuity of care are suboptimal for this patient population.
Quality of life for cardiac patients at the end of their lives, and their families, is poor. The symptom burden is similar to that of cancer. Most patients and families lack the knowledge and understanding of their condition and prognosis and find their healthcare needs are poorly addressed. Provision, coordination, uptake and continuity of care are suboptimal for this patient population.
Palliative care with its holistic approach should be integrated into heart failure care, but this requires clarification of the various roles of the healthcare providers and guidelines on when to refer patients for specialized care. Heart failure staff needs special training in communication, psychosocial support and the palliative care.
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