Palliative key aspects are of importance for symptom relief during the last week of life in patients with heart failure

Abstract

Aims This study aimed to describe symptom prevalence of pain, shortness of breath, anxiety, and nausea and to identify factors associated with symptom relief in patients with heart failure during their last week of life.Methods and results This nationwide study used data from the Swedish Register of Palliative Care and the Swedish Causes of Death Certificate Register. The sample included 4215 patients with heart failure as the underlying cause of death. Descriptive statistics and logistic regression were used to analyse data. Pain was the most prevalent symptom (64.0%), followed by anxiety (45.1%), shortness of breath (28.8%), and nausea (11.4%). Pain was the most often totally relieved (77.5%), followed by anxiety (68.4%), nausea (54.7%), and shortness of breath (37.1%). Key aspects of palliative care such as documented palliative care in the patient record, individual medication prescriptions by injection, symptom assessment with validated scales, documented end-of-life discussions with patients and/or family members, and external consultation were significantly associated with symptom relief. Relief of pain, shortness of breath, anxiety, and nausea were significantly better managed in nursing homes and hospice/inpatient palliative care compared with care in hospitals. Conclusions The results show that key aspects of palliative care during the last week of life are significantly associated with symptom relief. Increased access to palliative care could provide a way to improve care during the last week of life for patients with heart failure. Home-based settings provided more symptom relief than hospitals, which may indicate that the latter focuses on treatments and saving lives rather than promoting life before death.

Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care

“…107 EOL care includes not only relief of congestion and improvement of end-organ perfusion (see chapters above) but also psychosocial support, treatment of anxiety and depression, and, in the final stages, relief of dyspnoea with opioids or benzodiazepines as second line-treatment. 108 The PAL-HF (Palliative Care in Heart Failure) trial enrolled 150 patients with end-stage HF. Seventy-five patients were treated with a multidisciplinary palliative approach, while the others received standard care.…”

“…The HFA of the ESC has recently published a position paper providing a day‐to‐day practical clinical guidance on palliation strategies 107 . EOL care includes not only relief of congestion and improvement of end‐organ perfusion (see chapters above) but also psychosocial support, treatment of anxiety and depression, and, in the final stages, relief of dyspnoea with opioids or benzodiazepines as second line‐treatment 108 …”

State of the Science: The Relevance of Symptoms in Cardiovascular Disease and Research: A Scientific Statement From the American Heart Association

“…36 For some patients with HF, pain increases toward the end of life and can be exacerbated by physical limitations. 37 In addition to physical symptoms, 25% to 30% of adults with HF report mood disturbances, manifesting primarily as depressive and anxiety symptoms, that are independently associated with poor clinical outcomes. 38 In HF, physical and affective symptoms frequently cluster together regardless of cultural differences, 39 and such symptom clusters are associated with a gradient in clinical event risk.…”

Perceived symptoms as the primary indicators for 30-day heart failure readmission

“…Patients who are hospitalized for HF have experienced significant symptomatic decline and an acute decompensation of this chronic disease. Patients with HF often benefit from palliative care for the management of the highly prevalent symptomatic experience, a hallmark of this disease, in addition to contemporary guideline-based care with HF disease modifying therapies [ 67 , 68 ]. Our study underscores the complexity of care that HF patients face daily including the management of intricate medication regimens, challenging comorbidities such as diabetes mellitus and chronic kidney disease, and burdensome manifestations such as dyspnea and fluid retention.…”