Self-care at the End of Life in Patients With Heart Failure

Abstract

Promoting adherence to self-care illness management strategies among patients with heart failure (HF) has been associated with a number of positive health outcomes. Yet, little is known about health outcomes related to self-care in the "sickest of the sick"-those patients with advanced HF who are approaching the end of life. Clinicians and researchers must determine how self-care interventions are defined in the advanced HF population. For example, what is meant by self-care illness management in patients who are symptomatic with exertion may differ from that of patients who are predominantly symptomatic at rest. Our challenge is to develop the simplest, least burdensome self-care illness management interventions that target the most meaningful outcomes for patients, their families, and the healthcare system.

Biomarkers of Myocardial Stress and Systemic Inflammation in Patients Who Engage in Heart Failure Self-care Management

“…Instead, increased involvement of clinical experts and advanced monitoring and treatment therapies may be needed to decrease myocardial stress and systemic inflammation and minimize the risk of the associated clinical outcomes. Zambroski articulated the importance of promoting self-care of HF even in palliative care settings 52. But, the progressive nature of this multisystem disorder will at some point dominate over self-care in all persons with HF.…”

Relationship Between Self-care and Health-Related Quality of Life in Older Adults With Moderate to Advanced Heart Failure

“…17 Each of these factors is more prevalent in the olderadult population. 7 Patients older than 65 years are more likely to meet the criteria for moderate to advanced HF, meaning that they are more likely to both be symptomatic and suffer significant functional limitations. In addition, there is a strong relationship between older age and deteriorating cardiac status.…”

“…18 Managing multiple medication and dietary regimens while determining what is causing his/her symptoms and then making decisions regarding treatment choices can stress the ability and capability of the older individual, whether patient or caregiver. Zambroski,7 in reviewing the literature on self-care in advanced HF, notes the need for targeted and meaningful self-care strategies for those identified as ''the sickest of the sick. 7 Patients older than 65 years are more likely to meet the criteria for moderate to advanced HF, meaning that they are more likely to both be symptomatic and suffer significant functional limitations.…”

Psychometric testing of the self‐care of heart failure index version 6.2

“…Self‐care of HF has been demonstrated to improve QOL and reduce emergency department visits, hospital admissions, and mortality (Buck et al, ; Lee, Carlson, & Riegel, ; Wang, Lin, Lee, & Wu, ; Zambroski, ). The American Heart Association and the European Society of Cardiology (Lainscak et al, ; Riegel et al, ) recommend that self‐care be improved by providing educational programs to HF patients.…”