This article explains the role of palliative care in patients with heart failure.
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.
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.
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.
Reduced ability to exercise.
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.
Symptoms of heart failure in children may include:
Difficulty concentrating or decreased alertness.
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:
Family history of heart failure.
Heart attack (myocardial infarction).
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.
Reducing stress levels.
The medications used to treat heart failure by the doctor may include:
ACE (angiotensin converting enzyme) inhibitors.
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.
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:
Palliative medical treatment of heart failure.
Education of the patient and his family.
Accompaniment by the doctor and the caregivers.
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.
Repeated simple movements in the chair or the bed.
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.
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.
The four stages of heart failure are,
- Stage A - More likely to get heart failure.
- Stage B - Do not have symptoms of heart failure but are diagnosed with systolic left ventricular dysfunction.
- Stage C - Present with systolic heart failure and symptoms such as shortness of breath, fatigue, and less ability to exercise.
- Stage D - Present with systolic heart failure and advanced symptoms.
The main cause of heart failure is the previous history of another heart condition. The most common conditions that lead to heart failure are
- Heart attack.
- High blood pressure.
- Coronary artery disease.
The life expectancy of congestive heart failure varies depending on:
- The severity of the condition.
It is said that almost half the people with congestive heart failure will survive beyond a period of five years, 30% of people for ten years and people who received heart transplantation after a heart failure will survive for a period of 20 years.
There are different types of heart failure, such as left-sided heart failure and right-sided heart failure, which can sometimes be on both sides. Heart failure can also be classified as diastolic heart failure and systolic heart failure.
- Left-sided heart failure - It is the commonest type and occurs when the heart's left ventricle does not pump enough blood around the body.
- Right-sided heart failure - The heart's right ventricle cannot pump enough blood to the lungs. It mostly occurs due to left-sided heart failure making the right side work hard, causing stress.
- Biventricular heart failure - Affecting both sides of the heart.
The worsening signs of heart failure are
- Irregular heartbeat.
- Edema in legs, ankles, and feet.
- Chest pain (due to heart attack).
- Decreased ability to exercise.
- Weight gain.
- Loss of appetite.
- Persistent cough.
- Coughing pink foamy mucus.
- Increased frequency of urinating at night.
- Difficulty in concentrating.
Heart failure cannot be reversed, but sometimes treatment can improve the signs and symptoms to live longer. Taking care of personal health with a good lifestyle and medications prescribed by the doctor will make you feel better rather than getting worse. Lifestyle changes should include:
- Reducing the intake of salt.
- Managing stress.
- Losing weight to improve the quality of life.
When the patient's life expectancy is six months or less than that, then it is considered an end-stage heart failure. The symptoms of end-stage heart failure are
- Lack of appetite.
- High heart rate.
Sleeping on the left side is good when you have heart failure because when you sleep on the right side, increased pressure smashes against the blood vessels; while you sleep on the left side with the right side not squished, it will increase the blood flow to the heart. Also, when you have an implanted defibrillator, you should sleep on the opposite side.
Heart failure worsens when we lie flat and causes sleep problems like obstructive sleep apnea (OSA) and insomnia. Sleep disturbances make the heart failure symptoms get worse as a good night’s sleep is important for a healthy heart and mind.
As the heart works overtime, it will make us feel tired and sleepy. Heart failure causes shortness of breath, feeling weak, and fatigue over the day, where fatigue is the commonest sign of congestive heart failure.
The heart is unable to pump enough blood to the body tissues to meet the needs, making us feel tired all the time with difficulty in doing the daily routine activities such as sweeping, walking, climbing stairs, shopping., etc. Fatigue also occurs due to,
- Poor sleep.
- Poor diet.
Heart failure causes rapid changes in body weight. When the body is accumulated with fluid due to heart failure, it will result in weight gain. When the body loses the fluid after appropriate treatment, there will be a loss of weight.
Last reviewed at:
21 Jun 2022 - 4 min read
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