Chronic heart failure

December 2010

FocusChronic heart failure

End stage heart failure patients

Palliative care in general practice

Volume 39, No.12, December 2010 Pages 916-920

David C Currow

Patricia M Davidson

Peter S Macdonald

Phillip J Newton

Background

Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms.

Objective/s

This article summarises the fundamentals of implementing palliative care in general practice and provides guidelines on caring for chronic heart failure patients at the end of life.

Discussion

The high mortality in chronic heart failure underscores the importance of effective communication, symptom management and advanced care planning. The unpredictability and uncertainty around the timing of death mean that individuals, and their families, may be less likely to have an understanding of their prognosis or have access to supportive and palliative care. Ideally, patients with symptomatic chronic heart failure should be managed in collaboration with a multidisciplinary heart failure program. Symptom management can be achieved by additive therapies and access to specialist palliative care services should be considered when the symptom burden is high.

Chronic heart failure (CHF) is common, and more than half of patients diagnosed with CHF will die within 5 years.1,2 Medical advances, particularly beta blocker therapy and implantable cardiac defibrillators,3 mean that many individuals with CHF are living longer and cared for in the community. Patients with CHF experience a wide range of frequently distressing symptoms and in addition to breathlessness, pain, nausea and constipation, low mood is common and generally poorly controlled.1,4–6 The symptom burden is of similar severity to patients with cancer,7 therefore integrating supportive care into CHF treatment is important in both primary and secondary care settings.

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Correspondence afp@racgp.org.au

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Type

Focus

2010