The need for end-of-life discussions in patients with advanced heart failure
Dr. Simcha Shapiro
An Assessment of the Current Status on the Palliative Care in Patients with End-of-life Stage Heart Failure
According to the recommendations and guidelines for palliative care in end-stage heart failure, the health-care professionals should inform patients and their family about prognosis, life-prolonging procedures and the role of the palliative care and the hospice program. However, very few patients have discussed about their wishes for medical care at the end-of-life in advance. There still remain a lot of issues to be resolved about palliative care in end-stage heart failure. Of the 1044 patients with heart failure who admitted in our hospital between April 2010 to July 2013, 68 patients died. We investigated the medical records of these 68 deceased patients retrospectively. Of the 68 patients, 36 patients were hospitalized due to acute heart failure that includes acute myocardial infarction, and 32 patients were due to acute exacerbation of chronic heart failure. Of the 32 patients with chronic heart failure, 19 patients were readmission. The only one patient was informed his prognosis and confirmed his willingness of future medical treatment at the end-of-life in advance, and 4 patients were received palliative care including continuous subcutaneous infusion of morphine in collaboration with palliative care team. We need to consider questions about palliative care for patients with end-stage heart failure, including optimal timing of initiation, preferable team, opioid administration, willingness of life prolonging therapy, and resuscitation.
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