End of Life Care in Heart Failure

Question 1

Why do you need to consider EoL care with HF

Answer 1

Terminal condition with high mortality despite advances in treatment
-treatment and disease progression can be unpredictable

Support people in their QoL
Symptoms can be managed

Question 2

When to consider EoL care

Answer 2

3+ non elective admissions in last 6 months
NYHA 3+
Refractory symptoms, low Na, albumin
Renal decline
Increased frailty

Would you be suprised if the patient passed away in 6-12 months?

Question 3

What areas to consider at EoL care

Answer 3

Physical health and symptoms
Psychological factors
Spirituality
Self-care behaviours
Social factors
Economic factors

Question 4

Aims of EoL care

Answer 4

Establish patient wishes and individual QoL goals

Question 5

Effective communication

Answer 5

Take time to understand
Empathy
Open questions and explore
Be honest but kind
Give written information
Have several discussions

Question 6

What to discuss

Answer 6

Who does the patient want involved in their care?
-1 key nominated family member

Establish patient wishes, should their illness seriously worsen given they are not as well as they are now

Explore patient values and beliefs

DNACPR discussion?
Written and signed advance decisions?

Question 7

What are the ceilings of care

Answer 7

Will interventions work?
-risk benefit discussion?
 What is the aim of the intervention?
What are the patient's thoughts on this
What are the possible outcomes?
Impacts on QoL?

Question 8

Discussions of ICD deactivation

Answer 8

When resus issues explored

• worsening condition?
• hospice, home EoL care considered
• palliative care referral considered?

What is the effect of turning the ICD off?

ICD is patient property => needs consent for deactivation
Emergency deactivation can be done with a magnet temporarily, gives you time to get consent for formal deactivation