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Management of Advanced Heart Failure Patients

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Essentials of Palliative Care

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Abstract

The incidence of heart failure (HF) patients in the USA is estimated to be around six million, with half a million new cases adding each year) [1, 2]. It is associated with high symptom burden, frequent hospital admissions, diminished quality of life, high costs, and remains the leading cause of death in the USA [3, 4]. It is expected that 70–80 % of patients younger than age 65 will die within 8 years of their HF diagnosis, despite the availability of new medical and surgical options [2]. The evolution of HF in patients is typically characterized by acute crises or exacerbations followed by periods of stability lasting for months or even years. However, these patients are 6–9 times more likely to die of sudden cardiac death than the general population [2]. Several tools are available to help assess the prognosis in advanced HF patients: some are single-item predictors (such as the B-type natriuretic peptide [5], maximal oxygen consumption [6], creatinine level [7], other multivariable models (such as the Seattle Heart Failure Score [7] and the Acute Decompensated Heart Failure National Registry (ADHERE)) [8]. Similarly multiple prognostic factors are associated with increased likelihood of death in advanced HF, especially when coexistent: frequent emergency department visits or hospitalizations, symptoms at rest, dependency in activities of daily living, weight loss ≥ 10 %, albumin 2.5 g/dL, ejection fraction < 20 %, symptomatic arrhythmia, prior cardiopulmonary resuscitation, prior syncope, and embolic stroke. However, even while using these algorithms and other tools, life expectancy remains difficult to predict in advanced HF [3], and this is probably one of the reasons why less than 12 % of these patients benefit from hospice care [4].

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Author information

Authors and Affiliations

  1. Section of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, LA, USA

    Dominique Anwar M.D.

  2. Heart and Vascular Institute, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA

    Asif Anwar M.D.

Authors
  1. Dominique Anwar M.D.
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  2. Asif Anwar M.D.
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Corresponding author

Correspondence to Dominique Anwar M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Which is the global leading cause of death in the USA nowadays?

    1. (a)

      Cancer

    2. (b)

      Heart failure

    3. (c)

      Suicide

    4. (d)

      End-stage pulmonary diseases

  2. 2.

    What is the best tool to determinate an advanced HF patient prognosis?

    1. (a)

      Single-item tools

    2. (b)

      Multivariate models

    3. (c)

      Prognosis factors

    4. (d)

      All and none of them: prognosis in advanced HF remains difficult

  3. 3.

    What is the role of opioids in advanced HF?

    1. (a)

      None, the risk of respiratory depression is too high

    2. (b)

      Pain management only

    3. (c)

      Pain management and dyspnea

    4. (d)

      For dyspnea, it works only if associated with benzodiazepines

  4. 4.

    PM, ICD in patients who are referred to hospice:

    1. (a)

      Both need to be discontinued

    2. (b)

      PM needs to be discontinued

    3. (c)

      ICD needs to be discontinued

    4. (d)

      Both can be maintain and will improve the patient’s quality of life

  5. 5.

    LVAD as destination therapy:

    1. (a)

      Do not improve the quality of life

    2. (b)

      Do not present with severe complications

    3. (c)

      Are rather cheap

    4. (d)

      Can extend the duration of agony

Answers

  1. 1.

    (b)

  2. 2.

    (d)

  3. 3.

    (c)

  4. 4.

    (c)

  5. 5.

    (d)

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Anwar, D., Anwar, A. (2013). Management of Advanced Heart Failure Patients. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_21

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_21

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

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