Management of Heart Failure in Patients Nearing the End of Life–There is So Much More To Do

LeMond, Lisa; Goodlin, Sarah J.

doi:10.15420/cfr.2015.01.01.31

Cited by 9 publications

(7 citation statements)

References 45 publications

(27 reference statements)

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“…Simplified treatment regimens or supportive home care could enable compliance and potentially prevent hospitalization for acute HF decompensation 24 . Furthermore, although it was not addressed in this survey, discussing advance care planning is especially relevant in this patient group 25 …”

Section: Discussionmentioning

confidence: 99%

“…24 Furthermore, although it was not addressed in this survey, discussing advance care planning is especially relevant in this patient group. 25 Since lack of time and knowledge were the main reasons for the omission of cognitive screening by cardiologists, structured screening in cardiology clinics should be instituted to adequately recognize cognitive problems. Once cognitive problems are observed, patients should be referred to a multidisciplinary clinic where systematic cognitive assessment can be performed, while focusing on the connection between heart and brain.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

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Is it time for Heart–Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure

Nijskens,

Thomas,

Rhodius‐Meester

et al. 2024

Clinical Cardiology

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BackgroundCognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, practical guidance is lacking. In this study, we explore cardiologists' perspective on screening and care for cognitive impairment in patients with HF. We give an example of a multidisciplinary Heart–Brain care pathway that facilitates screening for cognitive impairment in patients with HF.MethodsWe distributed an online survey to cardiologists from the Dutch working groups on Geriatric Cardiology and Heart Failure. It covered questions about current clinical practice, impact of cognitive impairment on clinical decision‐making, and their knowledge and skills to recognize cognitive impairment.ResultsThirty‐six out of 55 invited cardiologists responded. Only 3% performed structured cognitive screening, while 83% stated that not enough attention is paid to cognitive impairment. More than half of the cardiologists desired more training in recognizing cognitive impairment and three‐quarters indicated that knowing about cognitive impairment would change their treatment plan. Eighty percent agreed that systematic cognitive screening would benefit their patients and 74% wished to implement a Heart–Brain clinic. Time and expertise were addressed as the major barriers to screening for cognitive impairment.ConclusionAlthough cardiologists are aware of the clinical relevance of screening for cognitive impairment in cardiology patients, such clinical conduct is not yet commonly practiced due to lack of time and expertise. The Heart–Brain care pathway could facilitate this screening, thus improving personalized care in cardiology.

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Section: Discussionmentioning

confidence: 99%

Section: Interpretation Of Findingsmentioning

confidence: 99%

Is it time for Heart–Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure

Nijskens,

Thomas,

Rhodius‐Meester

et al. 2024

Clinical Cardiology

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“…Based on the analgesic ladder proposed by the World Health Organization, pain should initially be managed using non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. 31 However, long-term use of NSAIDs is contraindicated in patients with ESHF since it can cause further fluid retention, kidney damage, and gastrointestinal bleeding. 27 Opioids are considered when non-opioid medications do not adequately alleviate the patient’s pain.…”

Section: Symptom Assessment and Managementmentioning

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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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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“…Decisions are made too late in the disease trajectory or not made at all, leaving the patient and their families unable to make informed choices (Allen et al, 2012;LeMond et al, 2015). As a consequence many of these patients die in an acute hospital bed (National Institute for Cardiovascular Outcomes Research, 2019) rather than their preferred place of care.…”

Section: Backg Rou N Dmentioning

confidence: 99%

A grounded theory study: Exploring health care professionals decision making when managing end stage heart failure care

Higginbotham

Jones

Johnson

2021

Journal of Advanced Nursing

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Management of Heart Failure in Patients Nearing the End of Life–There is So Much More To Do

Cited by 9 publications

References 45 publications

Is it time for Heart–Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure

Is it time for Heart–Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure

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

A grounded theory study: Exploring health care professionals decision making when managing end stage heart failure care

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