Palliative care in cardiology
Authors:
Martin Gřiva 1,3; Jiří Šťastný 1; Marie Lazárová 2,3; Helena Krejčíková 4
Authors‘ workplace:
Kardiologické oddělení, Krajská nemocnice T. Bati, a. s., Zlín
1; I. interní klinika – kardiologická Lékařské fakulty UP a Fakultní nemocnice Olomouc
2; Lékařská fakulta Univerzity Palackého, Olomouc
3; Centrum zdravotnického práva, Právnická fakulta Univerzity Karlovy, Praha
4
Published in:
Čas. Lék. čes. 2018; 157: 19-24
Category:
Review Article
Overview
Chronic heart failure is a progressive disease with an increasing prevalence. In spite of all medical progress (or thanks to it), it is finally one of the most common causes of death. Palliative care is an approach aimed to improve the quality of life of patients and their families in cases of life-threatening illness. Therefore, the use of palliative care in cardiology is entirely relevant. Estimating the course and prognosis of a patient with chronic heart failure is difficult despite many prognostic tools. This makes it difficult to find the moment when palliative care is to begin.
In general, gradual accentuation of treatment is recommended, focusing on the symptoms of the chronic progressive disease trajectory, and a reassessment of the benefit and potential adverse effects of conventional therapy. The main aspects of palliative care in cardiology are: 1. long-term communication with the patient and the family and their continuous education; 2. symptom-based treatment; 3. planning of advanced care; 4. A multidisciplinary team trying to meet all the patient's personality needs. Accepting palliative care as a part of complex care is a great challenge for the future of cardiology in the Czech Republic.
Key words:
heart failure, palliative care, cardiology
Sources
1. Ponikowski P, Voors AA, Anker SD et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891–975.
2. Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 2012; 33: 1750–1757.
3. Maggioni AP, Dahlström U, Filippatos G et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013; 15: 808–817.
4. Chun S, Tu JV, Wijeysundera HC et al. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail 2012; 5: 414–421.
5. Desai AS, McMurray JJV, Packer M et al. Effect of the angiotensin-receptor-neprilysin inhibitor LCZ696 compared with enalapril on mode of death in heart failure patients. Eur Heart J 2015; 36: 1990–1997.
6. SOLVD Investigators, Yusuf S, Pitt B, Davis CE et al. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302.
7. Narang R, Cleland JG, Erhardt L et al. Mode of death in chronic heart failure. A request and proposition for more accurate classification. Eur Heart J 1996; 17: 1390–1403.
8. Lainscak M, Anker SD. Prognostic factors in chronic heart failure. A review of serum biomarkers, metabolic changes, symptoms, and scoring systems. Herz 2009; 34: 141–147.
9. Komajda M, Lapuerta P, Hermans N et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J 2005; 26: 1653–1659.
10. Táborský M et al. Kardiologie. Mladá fronta, Praha, 2017.
11. Yancy CW, Jessup M, Bozkurt B et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62: e147–e239.
12. Liao L, Allen LA, Whellan DJ. Economic burden of heart failure in the elderly. Pharmacoeconomics. 2008; 26: 447–462.
13. Stewart S, MacIntyre K, Hole Dj et al. More 'malignant' than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 2001; 3: 315–322.
14. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symp Manage 2006; 31: 58–69.
15. World Health Organization. WHO definition of palliative care. Dostupné na: www.who.int/cancer/palliative/definition/en
16. Rogers JG, Patel CB, Mentz RJ et al. Palliative Care in Heart Failure: the PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol 2017; 70: 331–341.
17. Jaarsma T, Beattie JM, Ryder M et al. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2009; 11: 433–443.
18. Murray S, Boyd K. Using the "surprise question" can identify people with advanced heart failure and COPD who would benefit from a palliative care approach. Palliat Med 2011; 25: 382.
19. Small N, Gardiner C, Barnes S et al. Using a prediction of death in the next 12 months as a prompt for referral to palliative care acts to the detriment of patients with heart failure and chronic obstructive pulmonary disease. Palliat Med 2010; 24: 740–741.
20. Agrinier N, Schockmel M, Thilly N et al. Effectiveness of a patient education programme in heart failure with preserved ejection fraction: Results from the ODIN cohort study using propensity score matching. Arch Cardiovasc Dis 2018; 111: 5–16
21. Juillière Y, Jourdain P, Suty-Selton C et al. Therapeutic patient education and all-cause mortality in patients with chronic heart failure: a propensity analysis. Int J Cardiol 2013; 168: 388–395.
22. Kutner JS, Blatchford PJ, Taylor DH et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med 2015; 175: 691–700.
23. Martinez-Selles M. Adjusting cardiological pharmacological treatment at the end of life. Winter Summit in Palliative Medicine, Bydgoszcz, Poland, December 2017.
24. Narayan SW, Nishtala PS. Discontinuation of preventive medicines in older people with limited life expectancy: a systematic review. Drugs Aging 2017; 34: 767–776.
25. Krejčíková H. Právní aspekty deaktivace implantabilního defibrilátoru. In: Gřiva M (ed.): Paliativní péče v kardiologii. Triton, Praha, 2018: 184–187.
26. Barawid E, Covarrubias N, Tribuzio B et al. The benefits of rehabilitation for palliative care patients. Am J Hosp Palliat Care 2015; 32: 34–43.
27. Anker SD, John M, Pedersen PU et al. ESPEN guidelines on enteral nutrition: cardiology and pulmonology. Clin Nutr 2006; 25: 311–318.
28. von Haehling S, Anker SD. Prevalence, incidence and clinical impact of cachexia: facts and numbers – update 2014. J Cachexia Sarcopenia Muscle 2014; 5: 261–263.
29. Somers VK, White DP, Amin R et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008; 52: 686–717.
30. Gottlieb SS, Kop WJ, Thomas SA et al. A double-blind placebo-controlled pilot study of controlled-release paroxetine on depression and quality of life in chronic heart failure. Am Heart J 2007; 153: 868–873.
31. Ghosh RK, Ball S, Prasad V et al. Depression in heart failure: intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies. Int J Cardiol 2016; 224: 170–177.
32. Svatošová M. Víme si rady s duchovními potřebami nemocných? Grada, Praha, 2012.
33. Hughes S, Firth P, Oliviere D. Core competencies for palliative care social work in Europe: an EAPC white paper – part 1. Eur J Palliat Care 2014; 21: 300–305.
34. Hughes S, Firth P, Oliviere D. Core competencies for palliative care social work in Europe: an EAPC white paper – part 2. Eur J Palliat Care 2015; 22: 38–44.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
Most read in this issue
- Palliative care for patients at home
- Palliative care in nephrology
- The review of questionnaires and scales evaluating patients with amyotrophic lateral sclerosis
- Geriatric palliative care