Palliative Care in Heart Failure

Ghashghaei, Roxana; Yousefzai, Rayan; Adler, Eric

doi:10.1016/j.pcad.2016.01.002

Cited by 20 publications

(13 citation statements)

References 34 publications

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“…Management options for symptoms of advanced HF are outlined in Table 40. [585][586][587][588][589][605][606][607][608][609][610][611][612][613][614] Practical tip. The timing of advance care planning (ACP) discussions should take into consideration the high mortality rate in the year after a first HF hospitalization.…”

Section: Patient-level Considerationsmentioning

confidence: 99%

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

Ezekowitz

O’Meara

McDonald

et al. 2017

Canadian Journal of Cardiology

554

496

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Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.

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Section: Patient-level Considerationsmentioning

confidence: 99%

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

Ezekowitz

O’Meara

McDonald

et al. 2017

Canadian Journal of Cardiology

554

496

View full text Add to dashboard Cite

show abstract

“…16,20–22 Instead of palliative care, patients at end-of-life often receive intensive and costly care even when it may not contribute significantly to prolonging life. 12 Lack of GoC communication in advanced HF results in slow progression towards death with high symptom burden 23,24 and decreased quality of life, 25,26 increased length of stay in inpatient and intensive care units, and increased costs of care near the end of life. 5,27 Therefore, the purpose of the study was to determine if an intervention designed to assist patients in initiating GoC conversations with HF providers would result in increased numbers of GoC conversations, improved quality of communication with HF health care providers, referrals to palliative care services and completion of advance directives.…”

Section: Introductionmentioning

confidence: 99%

An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers

Doorenbos

Levy

Curtis

et al. 2016

Journal of Pain and Symptom Management

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Context Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes. Objectives To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives. Methods A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic HF clinic. The GoC intervention was a pre-visit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care and completion of advance directives. Results Patients averaged 58.15±11.26 years of age, with mean LVEF= 30.31±9.72%, and SHFM scores= 95.1±1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P<0.001) and quality of end-of-life communication (P=0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes. Conclusion The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer-term quality of care and patient outcomes.

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“…While evidence‐based research supports introducing palliative care early in the trajectory of HF, in actual practice palliative care is seldom introduced until late in the disease (Ghashghaei, Yousefzai, & Adler, ). Results from this study suggested that iSCIP strategies could serve as guide for starting the palliative‐care conversation earlier in care.…”

Section: Discussionmentioning

confidence: 99%

Does an intervention designed to improve self‐management, social support and awareness of palliative‐care address needs of persons with heart failure, family caregivers and clinicians?

Sebern

Sulemanjee

Sebern

et al. 2017

Journal of Clinical Nursing

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Palliative Care in Heart Failure

Cited by 20 publications

References 34 publications

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure

An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers

Does an intervention designed to improve self‐management, social support and awareness of palliative‐care address needs of persons with heart failure, family caregivers and clinicians?

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