Palliative Care in Heart Failure

Introduction:

Proper care in heart failure relieves symptoms, improves patient satisfaction, and decreases care costs. But, only a small fraction of end-stage heart failure patients receive palliative care consultation.

What Is Heart Failure?

Heart failure is a disease where the pumping action of the heart muscles is affected. When the heart muscles cannot pump the blood to the other parts of the body properly, it can lead to fluid build-up in the lungs and failure to provide the blood flow necessary for the body. Heart failure is usually developed slowly after heart damage caused by a heart attack or untreated hypertension or valvulopathy for a long time. It requires urgent medical intervention in severe cases.

What Can Be the Symptoms of Heart Failure?

The symptoms of heart failure are not always obvious and can range from mild to severe. In the initial stages of heart failure, people may appear symptomless. And, others may present with symptoms like:

• Fatigue and weakness.

• Rapid or irregular heartbeats.

• Chest pain.

• Reduced ability to exercise.

• Weight gain.

• Difficulty breathing with activity or while lying down.

• Fainting, in severe cases.

• Reduced blood supply to vital organs results in dizziness, tiredness, weakness, and confusion.

• Congested lungs (fluid-filled lungs) result in shortness of breath, dry cough, or wheezing.

• Fluid and water retention due to reduced blood supply to kidneys, resulting in swelling in the legs, ankles, feet, and abdomen, increased frequency of urination at night, and nausea.

• Loss of appetite.

• Persistent cough or wheezing.

• Sleeping difficulty.

Symptoms of heart failure in children may include:

• Poor feeding.

• Difficulty breathing.

• Excessive sweating.

• Difficulty concentrating or decreased alertness.

Who Is at Risk of Getting Heart Failure?

Some people are more prone to develop heart failure than others. We cannot predict who can get the disease, but certain known risk factors can cause heart failure. Understanding the risk factor and consulting the physician for early treatment is the right way to prevent and manage heart failure.

Risk factors for heart failure are:

• Hypertension.

• Diabetes.

• Family history of heart failure.

• Heart attack (myocardial infarction).

• Valve abnormalities.

• Cardiomyopathy.

Is There Any Way to Prevent Heart Failure?

Following some lifestyle changes recommended by the physician or the cardiologist can help alleviate the symptoms of heart failure and reduce the stress on the heart. They include:

• Limiting salt intake.

• Quitting smoking.

• Losing weight.

• Reducing stress levels.

How to Treat Heart Failure?

The medications used to treat heart failure by the doctor may include:

1. ACE (angiotensin converting enzyme) inhibitors.

2. Beta-blockers.

3. Anticoagulants.

4. Diuretics.

A cardiac resynchronization device is usually implanted in the heart, which sends tiny electrical pulses to the heart's lower chambers, thus allowing them to beat in a more coordinated or synchronized way. This device can improve the pumping efficiency of the heart. Cardiac resynchronization therapy (CRT) is used to resynchronize electrical activation and thereby resynchronize the contraction of the heart chamber to improve pace efficiency. This CRT is provided to patients with a leadless cardiac pacemaker and external heart equipment.

What Is the Significance of Palliative Care In Heart Failure Patients?

Palliative care is an approach to improve the quality of life of the patients facing a problem with a life-threatening illness and their families by providing physical, psychosocial, and spiritual support.

Three components that are essential for palliative care in heart failure include:

1. Palliative medical treatment of heart failure.

2. Education of the patient and his family.

3. Accompaniment by the doctor and the caregivers.

Palliative Medical Treatment of Heart Failure:

During palliative therapy, two points are necessary to emphasize, which include:

1. Optimal Use of Combination Therapy:

Diuretics + IEC (information education and communication) + beta-blockers and Ivabradine + Spironolactone or ARA II (angiotensin receptor antagonist). These can reduce the death rate under optimal conditions of use by 30 %, and it also does not aggravate the discomfort of the patient by hypotension, hyponatremia, bradycardia, or asthenia.

2. Regular Cardiological Follow-Up:

According to a study, adherence to treatment and patient education plays a significant role in the morbidity and mortality of heart failure patients. This emphasizes the importance of active follow-up. The knowledge of cardiac insufficiency is essential for every patient because they must know the importance of each medication. The doctor must inform the potential side effects of each drug group and the purchase of quality scales and cuff tensiometer for the patient to the family members for home follow-up.

Despite stages of heart failure, physical activity is necessary like:

• Reduced stair climbing.

• Walking in a corridor.

• Gymnastics.

• Repeated simple movements in the chair or the bed.

Education of the Patient and Family for Heart Failure:

Palliative care is a patient and family-centered strategy to promote physical, psychosocial, and spiritual health to the patient regardless of a diagnosis or prognosis. Relationships with the family are essential at this stage. The family member or the partner should monitor dyspnea and edema in the patient. They must be informed about the severity of the illness without worrying about it. Training should be provided on monitoring anticoagulant treatments, nitrates or diuretics, the amount of salt, and the adaptation of a balanced diet. The caregiver must acquire specific knowledge that must be adapted to each person, to each couple, according to the ability and anxiety. The doctor and the care team are the guarantors of this learning.

Conclusion:

Palliative care is beneficial to patients with heart failure and should be available to them. Around 20 million people require palliative care in the world each year. There are barriers in providing appropriate palliative care to these patients like variable clinical presentation, lack of robust evidence base, and limited funding for research.