PALLIATIVE CARE IN CARDIAC FAILURE

Palliative Care In Cardiac Failure And The Uses Of The Liverpool Care Pathway

Palliative care in cardiac failure and the uses of the Liverpool care pathway

Introduction

According to Guyatt; “The understanding and management of heart failure has changed dramatically over the last 20 years. Medication has expanded and advances in expertise have supplied additional treatment options with various devices”. (Guyatt 2009: 101)Cardiac surgery techniques extend to evolve, and research progresses in molecular and genetic approaches to management. With so many options, it is unsurprising that cardiologists can overlook that patients will pass away from their disease, and that even while active treatment is appropriate, patients will advantage from good supportive care, taking into account the effects of illness on all domains of life.(Ekman,2004, 724) It is tough to identify deterioration despite optimum treatment and when a change of goal is needed; the end stage trajectory is not as clear as for cancer.

According to Gannon there is increasing acknowledgement in both palliative care and cardiology communities that the distress, psychosocial and spiritual concerns suffered by this assembly of patients should be addressed.4 _ 12 In spite of this, there is little improvement. (Gannon 2005:11) Progress is patchy and dogged by the difficulties of historical approaches, and employed with voluntary sector organizations whose funding is often precarious, cancer-focused and who are concerned about potentially overloading the service. There is anxiety that precious beds in short stay acute units will become impeded by patients with severe debility, but not imminently dying. Other concerns have middled on the acceptability of 'hospice' or 'palliative care' to patients with heart failure, although where patient satisfaction has been assessed, this has not appeared to be a problem.13,14 There is also question that hospice staff have the necessary skills for such patients. In a hospital-based questionnaire, Dharmasena and Forbes,15 described that if the palliative care service expanded to non-malignant patients, then 94% of responding physicians would consider referral, but with a shared care approach to address such concerns. In the book of Gibbs, Scarborough area (population: 220 000) a junction approach from cardiologist and palliative physician was set up in September 2000 with some simple referral criteria(Gibbs 2002: 36). Patients have access to all specialists palliative care (SPC) services except community palliative care nurse specialists, although at the time of composing, this has now been added. This paper describes the service so far, in an attempt to address some of the above reservations.

 

 Discussion

Heart failure (HF) is an increasingly prevalent clinical syndrome that limits extent of life and deeply impacts function and quality of life. Recent epidemiologic analysis demonstrates increasing incidence and advanced survival of persons with HF, resulting in a increasing population of individuals dwelling with HF(Gibbs 2006), who by delineation are symptomatic. Heart failure is responsible for significant health care system and individual burden. As therapies for HF advance survival, increasing numbers of HF patients reside with this burden; many have advanced HF, and large numbers, by virtue of being vintage, have ...