Heart & Circulatory Health

Palliative Care in Heart Failure

Written by
Dr. Karim Hnid
and medically reviewed by iCliniq medical review team.

Published on Jan 30, 2017 and last reviewed on Sep 07, 2018   -  5 min read

Abstract

Abstract

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

Palliative Care in Heart Failure

Heart failure is a condition, which has a set of symptoms where the heart cannot provide the blood flow necessary for the needs of the body. Heart failure usually develops slowly after a heart damage caused by a heart attack or excessive heart fatigue after years of untreated hypertension or valvulopathy.

Symptoms of Heart Failure:

The symptoms of heart failure are not always obvious. In the early stages of heart failure, some people have no symptoms. And, others may present symptoms such as fatigue or breathing difficulty due to old age. Sometimes, the symptoms of heart failure are more obvious. Due to the inability of the heart to efficiently feed your organs, such as the kidneys and the brain, you may experience breathing difficulty, swelling of the feet and legs, lack of energy, tiredness, sleeping difficulty at night due to breathing problems, swelling of the abdomen, loss of appetite, etc.

Risk Factors for Heart Failure:

Some people are more likely than others to develop heart failure. No one can predict who will develop it, but there are known risk factors. Knowing the risk factors and consulting a doctor for early treatment is a good strategy for managing heart failure. Risk factors for heart failure are hypertension, heart attack (myocardial infarction), valve abnormalities, cardiomyopathy, family history of heart failure and diabetes. Your doctor may recommend lifestyle changes such as quitting smoking, limiting salt intake, lose weight or reduce stress levels. These changes can help alleviate some of the symptoms of heart failure and decrease the fatigue of your heart.

Treatment of Heart Failure:

Many medications are used to treat heart failure. Your doctor may prescribe ACE inhibitors, beta blockers, anticoagulants, and diuretics. A combination of drugs is used. The implantation of a cardiac device called a cardiac resynchronization device may be indicated. It sends tiny electrical pulses to the lower chambers of your heart to help them beat in a more coordinated or synchronized way. It can improve the pumping efficiency of the heart. Some people feel the need to meet other patients. Hospitals, health centers and local newspapers can provide information on patient associations or associations for the caregivers.

Palliative Care:

During palliative care in heart failure, three components are essential.

  1. Palliative medical treatment of heart failure.
  2. Education of the patient and his family.
  3. Accompaniment by the doctor and the caregivers.

During palliative therapy, two points are necessary to emphasize. Optimal use of combination therapy. Diuretics + IEC (information education and communication) + beta blocker and Ivabradine + Spironolactone or ARA II (angiotensin receptor antagonist). Each stage of which reduces the death rate under optimal conditions of use by 30 % insofar as it does not aggravate the patient's discomfort by hypotension, hyponatremia, bradycardia or asthenia.

Regular Cardiological follow-up:

Regardless of the stage of heart failure, adherence to treatment and patient education divide morbidity and mortality by 2, according to the Mahler multicenter study. This emphasizes the importance of active follow-up. The knowledge of the cardiac insufficiency is fundamental because the patient must understand his treatment to grasp the importance of each medication. It should also be informed of the potential side effects of each therapeutic class, and the purchase of a quality scales and cuff tensiometer is necessary for home follow-up. At all stages of heart failure, physical activity is theoretically a necessary complement, but it will be gradually decreased, depending on the patient's exhaustion such as reduced stair climbing, walking in a corridor, gymnastics, sometimes simple movements repeated in the chair or the bed without objective performance.

Education of the Patient and Family:

Relationships with the family are essential at this stage. Sometimes, it is the partner alone who ensures a watchful eye and participates in the monitoring of dyspnea and edema. So, they must be informed about the severity of the illness without worrying about it. Training in the monitoring of anticoagulant treatments, the use of nitrates or diuretics and the adaptation of a balanced diet and the amount of salt. The caregiver must acquire a certain knowledge, the doctor and the care team being, of course, the guarantors of this learning, which must be adapted to each person, to each couple, according to the knowledge and the anxiety of each one. It is hard to give a schema that will have to be adapted to the patient's sensitivity and the experience of the disease. This participation of the entourage is fundamental, especially during outbreaks of heart failure. It makes possible treatments that the patient could no longer provide alone. It makes it possible to mobilize it, to ensure a hygiene of life and a dietetic, which is impossible to guarantee in the isolated patient.

Rehabilitation, which could, before this palliative period, of course, be carried out in some specialized centers, is rather deleterious and exhausting in this context. It is at this stage that palliative care takes its place, but the mere evocation comes at first to offset the patient's vision of the long course of his illness sustained by the unrelenting hope of a prolonged life. The illusion of the omnipotence and endless mastery of this weak heart is brutally thwarted by the reality of the patient's exhaustion, permanent dyspnea and by the aggravation of edema. The work in collaboration with the generalist is essential here. Adjustment of strategies and consistency of discourse, in order not to induce contradictions or misunderstandings. This is the time for the progressive release and taking of modalities even in,

  • Acceptance of decreased exercise, periods of decubitus, especially in the elderly patient.
  • Tolerance of deviations of diet, because it is necessary to privilege feeding pleasure (the salt cursed will restore taste).
  • The decrease in biological controls, because the reduction of technical constraints is crucial for the quality of life in this period.
  • At the ultimate stage, use of small doses of morphine to slow tachypnea (starting with 3 mg to 5 mg orally, two to four times daily depending on the efficacy of symptoms) and sedative doses necessary and regular in front of an anguish and sometimes severe because it occurs while the subject is lucid.
  • Some particularly painful dyspneic situations, which the patient describes as unbearable, fall within the scope of the recommendations for continuous sedation for severe symptoms. These sedations are easier to perform in hospitals, but the involvement of an attentive generalist and good team of nurses makes this strategy also possible at home.

Sometimes, patients with severe heart failure but not letting go remain both eager to live and desperate for their addiction. A hospitalization in a palliative care unit, where the intensity of relational support will facilitate the end of life, can then be justified. These patients present insoluble logistical difficulties to the acute services because their lifespans far exceed the administrative possibilities of these services. Regarding the average length of stay, palliative care units often see these patients who, after 3 or 4 weeks of precarious situation enameled by episodes of terminal dyspnea leading to an imminent death, stabilize and continue for months a minimalist life. This time can sometimes give them the opportunity to move towards the gradual abandonment of activities that their bodies can no longer assume. But, in this context, we can guess all the work of accompaniment and psychological support necessary for these patients and confronted with an incomprehensible prolongation of the patient's slowed-down life. The desire for life that persists beyond this ineffective myocardium that is the real delicate challenge, and it requires a great humility to accompany the great cardiac insufficiency.

To understand more about palliative care in heart failure, consult a congestive heart failure specialist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist/congestive-heart-failure

Last reviewed at:
07 Sep 2018  -  5 min read

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