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Palliative Care in the Management of Patients with Advanced Heart Failure

  • Susan E. LoweyEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1067)

Abstract

Globally, there are 18-million individuals living with heart failure, a disease that is responsible for 12–15 million office visits and 6.5 million inpatient hospitalizations each year. As HF becomes advanced or end-stage, patients often live in a cycle of frequent transitions between care settings, and with unmet needs, including distress from inadequately managed symptoms. Prognostication in patients with heart failure can be challenging due to the unpredictable exacerbating-remitting illness trajectory that is associated with this progressive disease. Recurrent hospitalizations, worsening functional status and refractory symptoms, despite optimal therapies, are among the most salient predictors indicating that patients with advanced heart failure are nearing the end of life. Palliative care is a specialized form of medical care that has been shown to help improve severity of symptoms, facilitate discussions regarding medical decision making/advance care planning, and provide support for patients and their families. Palliative care can be used alongside curative treatments and has been shown to improve patient satisfaction and quality of life. Anorexia-cachexia syndrome, dyspnea, fatigue, pain and depression are among the most common symptoms experienced by patients suffering from advanced heart failure. Palliative care can help alleviate these symptoms and also facilitate conversations about decision making surrounding resuscitation status and use or deactivation of medical devices, such as an implantable-cardioverter-defibrillator (ICD). Clinical practice guidelines from the American College of Cardiology and American Heart Association report that aggressive life-sustaining treatments and therapies should not be utilized in patients with advanced heart failure who have refractory symptoms that are not responding to medical therapy. The focus of care should switch to controlling symptoms, reducing hospital admissions and improving health-related quality of life, which can be supported by the incorporation of palliative care into the treatment plan.

Keywords

Advanced care planning Advanced heart failure End-of-life care Heart failure Palliative care Symptom management 

References

  1. Abernathy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C (2003) Randomized, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. Brit Med J 327:523–528CrossRefGoogle Scholar
  2. Adler ED, Goldfinger JZ, Kalman J, Park ME, Meier DE. Palliative care in the treatment of advanced heart failure. Circulation 2009; 120: 2597–2606CrossRefPubMedGoogle Scholar
  3. Allen LA, Rogers JG, Warnica JW, DiSalvo TG, Tasissa G, Binanay C et al (2008) High mortality without ESCAPE: the registry of heart failure patients receiving pulmonary artery cathethers without randomization. J Card Fail 12:661–669CrossRefGoogle Scholar
  4. American Academy of Hospice & Palliative Medicine (n.d.). Statement on Physician-Assisted Dying [Internet]. Available from: http://aahpm.org/positions/pad
  5. American Heart Association. Types of heart failure [Internet]. [2017a May]. Available from http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp#.WYtMlrkm4dU
  6. American Heart Association. Advanced heart failure [Internet]. [2017b May]. Available from: http://www.heart.org/HEARTORG/Conditions/HeartFailure/Advanced-Heart-Failure_UCM_441925_Article.jsp#.WYy6v7km4dU
  7. American Heart Association. Heart disease and stroke statistics fact sheet [Internet]. [2017c Jan 25]. Available from: https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_491265.pdf
  8. American Heart Association (n.d..) Implantable Cardioverter Defibrillator [Internet]. Available from: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Implantable-Cardioverter-Defibrillator-ICD_UCM_448478_Article.jsp#.WaMIAbkm4dUGoogle Scholar
  9. Arenella C (n.d.) Artificial nutrition and hydration at the end of life: Beneficial or harmful? [Internet]. Available from https://americanhospice.org/caregiving/artificial-nutrition-and-hydration-at-the-end-of-life-beneficial-or-harmful/
  10. Bausewein C, Booth S, Gysels M, Higginson IJ. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database of Systematic Reviews. 2008; Issue 2. Art. No.: CD005623.  https://doi.org/10.1002/14651858. Available from https://www.researchgate.net/profile/Sara_Booth4/publication/5426782_WITHDRAWN_Nonpharmacological_interventions_for_breathlessness_in_advanced_stages_of_malignant_and_non-malignant_diseases/links/5416f7fb0cf2fa878ad43ae1/WITHDRAWN-Non-pharmacological-interventions-for-breathlessness-in-advanced-stages-of-malignant-and-non-malignant-diseases.pdf
  11. Berry P, Griffie J (2015) Planning for the actual death. In: Ferrell BR, Coyle N, Paice JA (eds) Oxford textbook of palliative nursing, 4th edn. Oxford University Press, New York, pp 515–530Google Scholar
  12. Bookbinder M, McHugh ME. Symptom management in palliative care and end of life care. Nurs Clin N Am 2010: 45: 271–327.  https://doi.org/10.1016/j.cnur.2010.04.002CrossRefPubMedGoogle Scholar
  13. Breault JL (2011) DNR, DNAR, or AND? Is language important? Ochsner J 11:302–306. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241061/pdf/i1524-5012-11-4-302.pdfPubMedPubMedCentralGoogle Scholar
  14. Brody H, Hermer LD, Scott LD, Grumbles LL, Kutac JE, McCammon SD (2011) Artificial nutrition and hydration: the evolution of ethics, evidence, and policy. J Gen Intern Med 26(9):1053–1058.  https://doi.org/10.1007/s11606-011-1659-zCrossRefPubMedPubMedCentralGoogle Scholar
  15. Buckholz GT, von Gunten CF. Nonpharmacological management of dyspnea. Curr Opin Support Palliat Care 2009; 3: 98–102CrossRefPubMedGoogle Scholar
  16. Center to Advance Palliative Care. Building a palliative care program [Internet]. 2011. Available from http://www.capc.org/building-a-hospital-based-palliative-care-program/
  17. Costanzo MR, Mills RM, Wynne J (2008) Characteristics of stage D heart failure: insights from the acute decompensated heart failure National Registry Longitudinal Module (ADHERE LM). Am Heart J 155:339–347CrossRefPubMedGoogle Scholar
  18. Coyle N, Layman-Goldstein M (2001) Pain assessment and management in palliative care. In: LaPorte-Matzo M, Witt-Sherman D (eds) Palliative care nursing: quality care to the end of life. Springer, New York, pp 362–486Google Scholar
  19. Diop MS, Rudolph JL, Zimmerman KM, Richter MA, Skarf LM (2017) Palliative care interventions for patients with heart failure: a systematic review and meta-analysis. J Palliat Med 20(1):84–92CrossRefPubMedPubMedCentralGoogle Scholar
  20. Dudgeon D (2015) Dyspnea, terminal secretions and cough. In: Ferrell BR, Coyle N, Paice JA (eds) Oxford textbook of palliative nursing, 4th edn. Oxford University Press, New York, pp 247–261Google Scholar
  21. Eliopoulos C (2014) Gerontological nursing, 8th edn. Wolter Kluwer Health, Philadelphia. 576 pGoogle Scholar
  22. End of Life Nursing Education Consortium (ELNEC) (n.d..) Core curriculum training program. City of Hope and American Association of Colleges of Nursing. Available from: http://www.aacn.nche.edu/ELNEC
  23. Evangelista LS, Sackett E, Dracup K. Pain and heart failure: unrecognized and untreated. Eur J Cardiovasc Nurs 2009; 8:169–173CrossRefPubMedPubMedCentralGoogle Scholar
  24. Fu MR, Lasinski BB (2015) Lymphedema management. In: Ferrell BR, Coyle N, Paice JA (eds) Oxford textbook of palliative nursing, 4th edn. Oxford University Press, New York, pp 279–296Google Scholar
  25. Glaser BG, Strauss AL (1965) Awareness of dying. Abingdon, Aldine Transaction. 305 pGoogle Scholar
  26. Goodlin SJ (2009) Palliative care in congestive heart failure. J Am Coll Cardiol 54:386–396CrossRefPubMedGoogle Scholar
  27. Heidrich DE, English N (2015) Delirium, confusion, agitation, and restlessness. In: Ferrell BR, Coyle N, Paice JA (eds) Oxford textbook of palliative nursing, 4th edn. Oxford University Press, New York, pp 385–403Google Scholar
  28. Heo S, Moser DK, Lennie TA, Fischer M, Smith E, Walsh MN et al (2014) Int J Nurs Stud 51:1482–1490CrossRefPubMedGoogle Scholar
  29. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al (2009) 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. Circulation 119:e391–e479CrossRefPubMedGoogle Scholar
  30. Hupcey JE, Kitko L, Alonso W. Patients’ perceptions of illness severity in advanced heart failure. J Hosp Palliat Nurs 2016; 18(2): 110–114CrossRefGoogle Scholar
  31. Katz AM, Konstam MA (2009) Heart failure: pathophysiology, molecular biology and clinical management, 2nd edn. Lippincott, Williams & Wilkens, Philadelphia. 335 pGoogle Scholar
  32. Lanken PN, Terry PB, DeLisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE et al (2008) An official American thoracic society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 177:912–927CrossRefPubMedGoogle Scholar
  33. Lee DS, Lee JS, Schull MJ, Grimshaw JM, Austin PC, Tu JV (2016) Design and rationale for the acute congestive heart failure urgent care evaluation: the ACUTE study. Am Heart J 181:60–65CrossRefPubMedGoogle Scholar
  34. Lowey SE, Norton SA, Quinn JR, Quill TE (2013) Living with advanced heart failure or COPD: experiences and goals of individuals nearing the end of life. Res Nurs Health 36:349–358CrossRefPubMedGoogle Scholar
  35. Lowey SE, Norton SA, Quinn JR, Quill TE (2014) A place to get worse: Perspectives on avoiding hospitalization from patients with end-stage cardiopulmonary disease. J Hosp Palliat Nurs 16(6):338–345CrossRefPubMedPubMedCentralGoogle Scholar
  36. Manalo MF (2013) End-of-life decisions about withholding or withdrawing therapy: medical, ethical, and religio-cultural considerations. Palliat Care 7:1–5. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147759/PubMedPubMedCentralGoogle Scholar
  37. Martinez-Selles M, Diez Villanueva P, Smeding R, Alt-Epping B, Janssen D et al. Reflections on ethical issues in palliative care for patients with heart failure. Eur J Palliat Care 2017; 24(1): 18–22Google Scholar
  38. McMillan SC, Small BJ, Haley WE, Zambroski C, Buck HG. The COPE interventions for caregivers of patients with heart failure. J Hosp Palliat Nurs 2013; 15(4): 196–206CrossRefGoogle Scholar
  39. Merriam-Webster. Trajectory [Internet]. [2017a]. Available from https://www.merriam-webster.com/dictionary/trajectory
  40. Merriam-Webster. Palliate [Internet]. [2017b]. Available from: https://www.merriam-webster.com/dictionary/palliate
  41. National Hospice and Palliative Care Organization. Hospice and palliative care [Internet]. 2014. Available from https://www.nhpco.org/palliative-care-4
  42. O’Neil-Page E, Anderson PR, Dean GE (2015) Fatigue. In: Ferrell BR, Coyle N, Paice JA (eds) Oxford textbook of palliative nursing, 4th edn. Oxford University Press, New York, pp 154–166Google Scholar
  43. Odermatt J, Hersberger L, Bolliger R, Graedel L, Christ-Crain M, Briel M et al (2017) The natriuretic peptide MR-proANP predicts all cause mortality and advserse outcome in community patients: a 10-year follow-up study. Clin Chem Lab Med 55(9):1407–1416CrossRefPubMedGoogle Scholar
  44. Patients Rights Council. Advance directives: Definitions [Internet]. 2013. Available from http://www.patientsrightscouncil.org/site/advance-directives-definitions/
  45. Pressler SJ, Gradus-Pizlo I, Chubinski SD, Smith G, Wheeler S, Sloan R et al. Family caregivers of patients with heart failure: a longitudinal study. J Cardiovasc Nurs 2013; 28(5): 417–428CrossRefPubMedGoogle Scholar
  46. Reisfield GM, Wilson GR (2007) Prognostication in heart failure #143. J Palliat Med 10(1):245–246CrossRefPubMedGoogle Scholar
  47. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W et al (2001) Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 345:1435–1443CrossRefPubMedGoogle Scholar
  48. Schmitter D, Cotter G, Voors AA (2014) Clinical use of novel biomarkers in heart failure: towards personalized medicine. Heart Fail Rev 19:369–381CrossRefPubMedGoogle Scholar
  49. Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manag 31:58–69CrossRefGoogle Scholar
  50. Start the Conversation.Org. Who pays for palliative care [Internet]. 2017. Available from: http://www.starttheconversationvt.org/palliative-care-hospice/palliative-care/who-pays-for-palliative-care
  51. Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V et al (2009) The support, education, and research in chronic heart failure study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. Am Heart J 157:84–90CrossRefPubMedGoogle Scholar
  52. Teuteberg JJ. Palliative care for patients with heart failure. American College of Cardiology, Latest in Cardiology [Internet]. [2016 Feb 11]. Available from http://www.acc.org/latest-in-cardiology/articles/2016/02/11/08/02/palliative-care-for-patients-with-heart-failure
  53. U.S. Department of Health and Human Services, National Heart Lung and Blood Institute. What is the heart? [Internet]. [updated 2011 November 17]. Available from https://www.nhlbi.nih.gov/health/health-topics/topics/hhw
  54. U.S. Department of Health and Human Services, National Heart Lung and Blood Institute. What is heart failure? [Internet]. [updated 2015a June 22]. Available from https://www.nhlbi.nih.gov/health/health-topics/topics/hf
  55. U.S. Department of Health and Human Services, National Heart Lung and Blood Institute. What causes heart failure? [Internet]. [updated 2015b June 22]. Available from https://www.nhlbi.nih.gov/health/health-topics/topics/hf/causes
  56. United States Census Bureau. An Aging Nation: The Older Population in the United States. U.S. Department of Commerce, Economics and Statistics Administration [Internet]. [2014 May]. Available from https://www.census.gov/prod/2014pubs/p25-1140.pdf
  57. Vermont Ethics Network. Palliative care and pain management: Importance of goals for Care [Internet]. 2011. Available from http://www.vtethicsnetwork.org/importance_of_goals.html
  58. von Haehling S, Lainscak M, Springer J, Anker SD (2009) Cardiac cachexia: a systematic overview. Pharmacol Ther 121(3):227–252CrossRefGoogle Scholar
  59. Whellen DJ, Goodlin SJ, Dickinson MG, Heidenreich PA, Jaenicke C, Gattis Stough W et al (2014) End-of-life care in patients with heart failure. J Card Fail 20(2):121–134CrossRefGoogle Scholar
  60. Wholihan D (2015) Anorexia and cachexia. In: Ferrell BR, Coyle N, Paice JA (eds) Oxford textbook of palliative nursing, 4th edn. Oxford University Press, New York, pp 167–174Google Scholar
  61. World Health Organization. WHO definition of palliative care [Internet]. 2014. Available from http://www.who.int/cancer/palliative/definition/en/
  62. World Health Organization. Cardiovascular Diseases Fact Sheet [Internet]. [2017a May]. Available from http://www.who.int/mediacentre/factsheets/fs317/en/
  63. World Health Organization. WHO’s cancer pain ladder for adults [Internet]. 2017b. Available from http://www.who.int/cancer/palliative/painladder/en/
  64. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH et al (2013) ACCF/AHA guideline for the Management of Heart Failure. J Am Coll Cardiol 62(16):1497–1539CrossRefGoogle Scholar
  65. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM et al (2017) ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the Management of Heart Failure. J Am Coll Cardiol.  https://doi.org/10.1016/j.jacc.2017.04.025. Available from http://circ.ahajournals.org/content/early/2017/04/26/CIR.0000000000000509
  66. Yennurajalingam S, Bruera E (2007) Palliative management of fatigue at the close of life. JAMA 297(3):295–304CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of NursingState University of New York College at BrockportNew YorkUSA

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