When considering palliative care, the large section of Oklahoma’s population living with congestive heart failure (CHF) cannot be overlooked. CHF has a major impact on the lives of patients and their families and the debilitating symptoms associated with end stage heart failure warrant medical professionals looking more closely at the benefits of palliative care for these patients.
Heart failure can be described as the inability of the heart to support the physiologic requirements of the body and carries a greatly increased mortality risk for patients. The incidence of heart failure is rising as the population is ages and the demand for acute and palliative care for cardiac patients is increasing. Heart failure is a complex syndrome that can result from a structural or functional disorder that impairs the hearts ability to pump effectively. The major cause of heart failure is coronary heart disease, however a number of other diseases such as cardiomyopathy, valvular disease and congenital heart disease can also result in heart failure. Heart failure results in debilitating symptoms such as breathlessness, extreme fatigue and lethargy, as well as signs of air hunger and fluid retention. The majority of patients with chronic heart failure use a combination of diuretic therapy, ACE inhibitor and beta blocker medications, however there are a large number of patients for whom these therapy options have been exhausted and whose condition is likely to deteriorate rapidly.
In the past there may have been some reluctance on the part of health care professionals to discuss death with patients and families affected by heart failure when treatment is no longer successful. However, palliative care is increasingly being seen as a treatment option which can afford patients improved quality of life by offering aggressive symptom control, psychological support and ultimately a peaceful and dignified death.
According to Ward (2002) communication with patients suffering from heart failure is generally perceived to be inadequate. Without adequate frank discussion about the debilitating symptoms which may arise as a result of cardiac failure that is unresponsive to treatment, depression and anxiety may well lead to further ill health for patients. Pain, dyspnea and altered mental status are common problems associated with heart failure and without the support of trained palliative care staff, patients often end up returning to the emergency room with exacerbation of symptoms which could be more effectively controlled under the care of hospice.
The goal of hospice is to afford dignity and quality of life in the face of terminal illness, however many patients are not aware that hospice care is an option, nor are they aware that hospice focuses on aggressively treating and controlling the symptoms that are causing pain and discomfort. It is therefore imperative that the healthcare community at large recognize when chronic conditions are no longer appropriate for curative care and provide education and support to patients about the value that palliative care can bring to their lives.
Odyssey HealthCare’s inpatient unit, Odyssey House, Oklahoma’s only acute care hospice inpatient facility, recognizes the multitude of problems that may arise for patients with end stage cardiac failure. Pulmonary edema, skin breakdown and worsening renal function may cause immense distress to patients and their families. The use of oxygen, positioning, assistance with daily living activities, meticulous skin care, appropriate medication for pain and respiratory distress and a calming environment contribute greatly to reducing the anxiety and discomfort experienced by these patients.
The focus of the inpatient unit is primarily on aggressive treatment of symptoms and takes hospice services to a new dimension in Oklahoma by providing multidisciplinary care and utilizing the latest research in pain and symptom control. Patients and their families are often reluctant to use opiates, however Odyssey House provides the education and support necessary in order to assist patients in making informed decisions about their care. Morphine can be extremely beneficial in aiding respiration and reducing anxiety for patients in congestive heart failure.
The ever increasing number of patients living with chronic heart failure in Oklahoma necessitates a forward thinking approach in order to explore options when treatment is no longer successful. Odyssey House is proving to be a valuable link in the treatment chain for cardiac patients and offers the hope of comfort and dignity to its patients and their families.
Colleen Folsch, BSN, RN, is a columnist, who holds a Masters Degree in Psychology and works for Odyssey House and St. Anthonys Hospital’s Critical Care Unit. She originates from Egypt and has an extensive background in HIV/AIDS care and counseling in London, England.