Consensus statement: palliative and supportive care in advanced heart failure

Goodlin, Sarah J.; Hauptman, Paul J.; Arnold, Robert M.; Grady, Kathleen L.; Hershberger, Ray E.; Kutner, Jean S.; Masoudi, Frederick A.; Spertus, John A.; Dracup, Kathleen; Cleary, James F.; Medak, Ruth E.; Crispell, Kathy; Piña, Ileana L.; Stuart, Brad; Whitney, Christy; Rector, Thomas S.; Teno, Joan M.; Renlund, Dale G.

doi:10.1016/j.cardfail.2003.09.006

Cited by 303 publications

(226 citation statements)

References 53 publications

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“…Néanmoins, les préférences des patients, relevées dans l'étude, peuvent guider les médecins dans la planification et l'amorce du dialogue sur le pronostic. related to prognosis discussions have been left almost completely unexamined in HF populations (4). There is currently little evidence to suggest that prognostic discussions about HF are based on patient preferences for either information or the communication process.…”

Section: Resultsmentioning

confidence: 99%

Preferences of patients with heart failure for prognosis communication

Caldwell

Arthur

Demers

2007

Canadian Journal of Cardiology

103

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Section: Resultsmentioning

confidence: 99%

Preferences of patients with heart failure for prognosis communication

Caldwell

Arthur

Demers

2007

Canadian Journal of Cardiology

103

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“…Indeed, patients with a normal LVEF and a recent HF hospitalisation may have a poorer prognosis [14,15]. More recently, an American expert group defined advanced HF as a "state in which patients have significant cardiac dysfunction with marked symptoms of dyspnoea, fatigue, or symptoms relating to end-organ hypoperfusion at rest or with minimal exertion despite maximal medical therapy" [16]. This definition is similar to the one that we propose, but does not include the criterion of a previous hospitalisation and does not try to objectively assess the impairment of cardiac dysfunction and functional capacity.…”

Section: Comparison With Previous Definitionsmentioning

confidence: 99%

“…Their key components are a multidisciplinary approach including adequate education for patients and carers, frequent monitoring of clinical status, and careful assessment of patient's compliance to therapy. Disease management programmes have been consistently shown to be associated with a reduction in hospitalisations and, in some studies and meta-analyses, mortality [1,2,16,76]. The ESC guidelines give HF management programmes a strong recommendation [1].…”

Section: Disease Management Programmesmentioning

confidence: 99%

“…The anticipated course of the disease (including prognosis), treatment options (including resuscitation and ICD inactivation) and planning of treatment and care (including hospice care, if available) should be discussed with the patient and family before he/she becomes too ill to participate in decision-making. Advance directives are decisions about desired treatments made by individuals and shared with loved ones and health care providers, although any decisions made should be reassessed at regular intervals as they may change over time [16,83].…”

Section: End Of Lifementioning

confidence: 99%

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Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

352

242

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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

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“…Recently, Canadian and international groups advocated for EOL planning and care for patients who have advanced HF (4,11). Outpatients with advanced HF attending a heart function clinic have said that they would prefer to have opportunities to discuss prognostic possibilities in a supportive, hopeful and open way when they feel well enough to process and participate in activities related to planning for EOL (9).…”

mentioning

confidence: 99%

Mind the gap: Opportunities for improving end-of-life care for patients with advanced heart failure

Strachan

Ross

Rocker

et al. 2009

Canadian Journal of Cardiology

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H eart failure (HF) is a complex and progressive condition associated with high morbidity and mortality rates, and considerable health resource use (1,2). Approximately 500,000 Canadians are living with HF and 50,000 new cases are diagnosed annually (3). Based on increases in the numbers of the aging population and improvements in the treatment of myocardial infarction, it is projected that the incidence of HF will double by 2025 (2). A recent analysis of 9943 patients in Ontario who were followed after an index hospitalization for HF identified a median survival rate of 2.4 years (4). Of these, patients who had a left ventricular ejection fraction of less than 30% had a one-year mortality rate of 33.3% and a five-year mortality rate of 65.8%. The high morbidity and mortality rates in patients who have HF clearly indicate that care of this patient population must be based on knowledge of what patients perceive as important issues related to end-of-life (EOL) care.Patients with HF tend to have a fluctuating trajectory of illness that has promoted a focus on acute care and optimization of treatment up to the time of death; this focus creates challenges for EOL planning and care (5,6). Specifically, this illness trajectory has contributed to uncertainty about predicting EOL in patients who have advanced HF (7,8) and the tendency to avoid discussions regarding EOL issues (9). Worsening symptoms, progressive decreases in functional capacity (1,10), an increasing frequency of hospitalizations, lower quality of life and increased reliance on informal caregivers (6) BACKGROUND:Patients with advanced heart failure (HF) experience progressive symptoms, decreased quality of life, and more frequent hospitalizations as they approach the end of life (EOL). Understanding patient perspectives and preferences regarding EOL issues is necessary to identify key opportunities for improving care. OBJECTIVE: To identify, from the patient's perspective, the major opportunities for improving EOL care for patients hospitalized because of advanced HF. METHODS: A cross-sectional survey of patient perspectives regarding EOL care was administered via interview of 106 hospitalized patients who had advanced HF in five tertiary care centres across Canada. The study compared which aspects of EOL care patients rated as 'extremely important' and their level of satisfaction with these aspects of EOL care to identify key opportunities for improvement of care. RESULTS:The greatest opportunities for improvement in EOL care were reducing the emotional and physical burden on family, having an adequate plan of care following discharge, effective symptom relief and opportunities for honest communication. The three most important issues ranked by patients were avoidance of life support if there was no hope for a meaningful recovery, communication of information by the doctor and avoidance of burden for the family. CONCLUSIONS: Advanced care planning that seamlessly bridges hospital and home must be standard care for patients who have advanced HF. Componen...

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Consensus statement: palliative and supportive care in advanced heart failure

Cited by 303 publications

References 53 publications

Preferences of patients with heart failure for prognosis communication

Preferences of patients with heart failure for prognosis communication

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Mind the gap: Opportunities for improving end-of-life care for patients with advanced heart failure

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