End-of-Life Care for End-stage Heart Failure Patients

Lee, Ju-Hee; Hwang, Kyung Kuk

doi:10.4070/kcj.2022.0211

Cited by 14 publications

(13 citation statements)

References 116 publications

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“…59 Significant distress due to multiple, frequent, and painful shocks and prolonged pain and death were noted in patients with ESHF; hence, deactivation was recommended as part of EOL care. 22 However, it was noted by Goldstein et al (2004) that the discussions of deactivating ICDs were not part of the initial advance directives for EOL care but were usually part of the reaction to patient distress nearing EOL. 58 Depending on the knowledge of the procedure and legal and ethical status of ICD deactivation, specialties differ in their experience and comfort with discussions on ICD deactivation.…”

Section: Implantable Cardioverter Defibrillatormentioning

confidence: 99%

“…21 Furthermore, it was cited that for various cultural, religious, and personal reasons, the symbolic significance of an attempt at CPR might be crucial for certain patients and their families. 22 Hence, EOL for patients with ESHF includes giving personal autonomy and respecting the decision of the patient and their family members regarding CPR, irrespective of the prognosis.…”

Section: When To Consider Eol Carementioning

confidence: 99%

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End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines

Rivera

Choi²,

Carado

et al. 2023

Am J Hosp Palliat Care

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Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care ( PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.

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Section: Implantable Cardioverter Defibrillatormentioning

confidence: 99%

Section: When To Consider Eol Carementioning

confidence: 99%

End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines

Rivera

Choi²,

Carado

et al. 2023

Am J Hosp Palliat Care

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show abstract

“…For such people, palliative and end-of-life care to enhance quality of life is critical. As in other end-stage diseases, transition to end-of-life care should be considered when quality of life is more important than quantity of life in patients with end-stage HF [ 91 ]. To address the underlying comorbidities and coordinate care for advanced HF, the intervention of a specialist is necessary because individualized care, rather than standardized therapy, is often required.…”

Section: Palliative and End-of-life Carementioning

confidence: 99%

Advanced heart failure: a contemporary approach

Park¹,

Kang²

2023

Korean J Intern Med

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Advanced heart failure (HF) is defined as the persistence of severe symptoms despite the use of optimized medical, surgical, and device therapies. These patients require timely advanced treatments, such as heart transplantation or long-term mechanical circulatory support (MCS). Inotropic agents are often used to reduce congestion and increase cardiac output, while renal replacement therapy may be beneficial if necessary. Cardiac resynchronization therapy has clear benefits in patients with HF with reduced ejection fraction, particularly with left bundle branch block (QRS duration > 130 ms). The role of implantable cardioverter-defibrillators in advanced HF patients requires further investigation considering the introduction of novel HF medications. In selected patients with significant secondary mitral regurgitation, transcatheter edge-to-edge repair can help delay heart transplantation or long-term MCS. In later stages, the appropriateness of heart transplantation should be evaluated, and the use of short- or long-term MCS may be considered. A multidisciplinary HF management program is crucial for patients with advanced HF. Recent treatment advances, including drugs, devices, and MCS, have broadened the options available to patients with advanced HF and this trend is expected to continue.

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“…End-of-life (EoL) care, though lacking a precise definition, generally refers to healthcare provided to individuals approaching death. This care encompasses ongoing treatment for the underlying disease, and palliative measures to manage symptoms and enhance the quality of life (QoL) [1]. The provision of EoL care typically involves a collaborative decisionmaking process, often supported by an established advanced care plan [1].…”

Section: Introductionmentioning

confidence: 99%

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

Hagen,

Zelko

2024

Healthcare

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Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were more commonly placed in nursing homes than patients in the two other groups, while patients with heart failure and breast cancer were more frequently hospitalized than the dementia patients. Breast cancer and heart failure patients had a higher likelihood of dying at home than dementia patients. The higher the number of general practitioners, the higher was the probability of home-based end-of-life care for cancer patients, while an increasing non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusions: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care. The higher the availability of health care services, the higher also is the probability of ending the life at home.

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End-of-Life Care for End-stage Heart Failure Patients

Cited by 14 publications

References 116 publications

End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines

End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines

Advanced heart failure: a contemporary approach

Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors

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