However, heart failure is a chronic condition with no cure. Over time, patients will reach the final stages of heart failure. During these late stages, the person feels breathless even while resting. However, the severity of their symptoms can fluctuate over days or hours.
The leading causes of heart failure are diseases that damage the heart, such as heart disease, high blood pressure, and diabetes. Sources: U. Heart failure worsens over time, so symptoms are most severe during the final stages. It causes fluid to build up in the body, which produces many of these symptoms:. Treatments, such as medications and healthier lifestyles, can help people with heart failure live longer, more active lives.
Palliative care — which increases comfort and reduces symptoms — can be given alongside other medical treatments. Some people with end-stage heart failure may also benefit from implanted devices that help the heart pump blood, or from a heart transplant. However, such invasive treatments also carry risks and potential downsides. Abstract Patients with congestive heart failure have a high incidence of sudden cardiac death that is attributed to ventricular arrhythmias.
Publication types Research Support, Non-U. Prevalence and mortality rate of congestive heart failure in the United States.
J Am Coll Cardiol. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Cardiovascular critical event pathways for the progression of heart failure; a report from the ATLAS study.
Age, sex and social trends in out-of-hospital cardiac deaeths in Scotland a retrospective cohort study. Clinical events leading to the progression of heart failure: new insights from a national database of hospital discharges.
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Close mobile search navigation Article Navigation. Volume 4. Article Contents Abstract. This is perhaps through the many years that I already have, even from my young years, I was always a bit limited.
The patients reported various anxieties that may manifest as the illness progresses, fear of helplessness and uncertainty about future care arrangements. Moreover, the fluctuating course of heart failure with repeated acute incidents and accompanying diseases multimorbidity can provoke the fear of disease progression and deterioration of personal wellbeing. In particular, the fear of losing mental function, which is expected with aging and the associated loss of independence, dominates in many cases:.
That is one thing that would be difficult for me. I think not only for us old people, but also for.. For those who largely appreciate their quality of life despite restricted physical wellbeing, aspects such as personality, a more positive attitude and social activity play an important role.
This contrasts with older patients who complain of a significant loss of quality of life. Correlations were found between restriction of personal autonomy and the loss of enthusiasm for life. The loss of personal independence can lead to a feeling of absence of will and increasingly shifts the focus on basic care needs.
This was observed in the case of a very old woman who was increasingly losing her will to live after moving into a nursing home, as identified at the fourth interview:. Overall, the interviewed cardiac failure patients had little knowledge about their condition and its limited prognosis.
The subjective need for information varies according to disease state and individual preferences. Thus, the majority of their information was gained directly via doctor-patient communication. Various motives regarding the wish to obtain information and knowledge or not related to how the patients dealt with their actual experience of the disease and were not inevitably related to the need to know medical facts.
At T0, one patient joked about how she had refused information regarding her illness in the beginning due to fears; after experiencing a time of severe stages of the disease, she later seemed chastened and somewhat wiser, although she was still frightened of bad news.
Especially in emergency situations such as acute shortness of breath, the patients and their relatives reported that they had little idea regarding the course of action in such emergency situations. The feeling of boredom was also described: time can no longer be used in a fulfilling way because the necessary energy, mobility and means are lacking.
In such cases, the patients longed for rather than rejected death and viewed life as having been lived. A main wish of the interviewed persons was to be able to carry out daily tasks without pain.
Particularly when pain and suffering dominate everyday life, the desire to die increases over time and, after a certain point, some interviewees were considering shortening their life. Nevertheless, the participants also expressed fears associated with the end of life. The wish for a peaceful, quick death without suffering was mentioned consistently.
Although most patients expressed a strong preference to die at home, specialist palliative care and facilities e. At the same time, some of the interviewees did not reject hospitalisation if pain became unbearable. Given the limited lifetime remaining, the respondents thought it particularly relevant that arrangements be made before they passed away.
Many patients said it was important to know that their family was provided for. What will still be there and remain when you are dead and gone? Yes, that reassures me now.
However, arrangements for the time before death, i. While all interviewees did not want life-prolonging treatments, they had a range of strongly divergent ways to express their wishes: from written statements of intent living wills and enduring powers of attorney to oral delegation of decision-making power to family members or primary representatives.
What is more, some made contradictory statements regarding the intention and implementation of advance directives. And still one thinks, I think, the doctors, if there is still a possibility that I might pull through or not pull through, regardless of the advance directive.
And if the doctors say there is.. Some patients, however, reject the living will completely because they see no need for this document or mistrust possible actions by physicians; thus, they are confident that their family will handle things without any written directions. Renewed inquiry during the sequential interview sessions suggested that this attitude did not change over time. For example, the following patient kept his strong confidence in the decision power of this family, which did not waver from T1 to T T6 I: … An advance directive about life-prolonging treatment, whether you want that or not?
P: No, I do not want that. Treatment of pain was particularly highlighted: The fact that patients often perceive pain as an expression of complete suffering not attributable to any particular organic cause leads to a type of indifference that makes any medical help inconceivable.
Pain everywhere …. In their individual preferences, the need for emergency intervention may be weighed against the wish for participatory decision-making. Thus, patients prioritize individual support preferences and negotiate specific treatment interventions depending on the situation. I mean, I do not want too much care, it would be too much responsibility for me, you know. Transition situations, i. Although all patients interviewed preferred to be cared for at home, joint discussions between doctor and patient regarding medical and therapeutic treatment options in ambulatory settings did not take place.
One patient perceived recurrent visits to a day unit in addition to visits by nursing and medical assistants as stressful:. In situations requiring increased nursing and medical care, the patients encountered different needs regarding both the intensity and frequency of interaction. Patients described situations that reveal a lack of attention and empathy at the professional and informal level. Increased care needs and concomitant dependencies can cause feelings of helplessness. Some of the nurses there were rather unpleasant.
And if I rang, there was a long delay; I would lie there in pain on my back or askew. This was consistently reflected in statements that they did not feel recognised, heard or taken seriously.
For example, when the patients reported symptoms such as shortness of breath or pain, they often got vague responses from their doctors, who put it down to old age or weather. He used to be a mason but re-trained.
This communication habit by professionals may not only lead to unanswered questions and dissatisfaction, but may also give older patients the impression that treatment options exist but are not being offered to them.
According to the respondents, it seems that the limits and possibilities of medical care and therapy are not being clearly addressed by health professionals. Many patients, on the other hand, would like to be informed and not be left in limbo when it comes to diagnosis or treatment. Because he [KK: the GP] he had us there … Here and there, there in the reports, he said something about heart failure without saying what it actually meant.
Those are two examples that spontaneously come to mind now. Then, I would have liked for him to have put it to me more clearly, and that he had said, you have this and that and need to watch out for this.
Informal caregivers, who are mostly family members, have a key role in health care support between patients and health professionals. They act and react on different levels: as an observer of professional health care situations , as a link between the parties, and as actively involved carers while, at the same time, they are affected themselves.
Our findings regarding the meaning of family were presented in a differentiated manner elaborating on diverse types of relationships monad, dyad, and triad. These findings will be published elsewhere please refer to Table 2. The results of this study show that old and very old patients with advanced heart failure often do not perceive heart failure as a life-limiting disease.
Restrictions of daily life weighed much more predominantly on their minds, irrespective of whether due to heart failure or other comorbidities. Pain resulting in reduced quality of life is an example of a major symptom requiring treatment in this population. The needs and priorities of older heart failure patients are diverse and vary according to the status of illness and individual preferences. Many older patients with cardiac failure lack sufficient knowledge of their disease, its prognosis and possible treatment options.
Especially issues regarding the handling of emergency situations and end of life care planning raise questions, and many patients expressed a desire for open discussions of these issues.
Many of the patients believe that their physicians do not openly communicate the limits of treatment and medical care to them. Contrary to the experiences of younger people with severe heart disease, the physical and social decline associated with co-morbidities, progressive losses and social isolation become the more prominent issues with increasing age [ 24 ].
This is consistent with the findings of Murray et al. Overall, current studies indicate that many cardiac failure patients have a poor understanding of the disease and its prognosis [ 6 , 25 ]. One problem might be that some doctors insufficiently inform their patients that advanced heart failure is a serious and fatal disease.
Perhaps due to a lack of confidence, barriers exist that hinder physicians from discussing a poor prognosis and end of life issues with their patients—a task that also requires a high level of communicative competence [ 26 — 29 ]. These aspects should be addressed in educational interventions designed to improve communication skills, particularly among primary care professionals [ 25 ].
Another problem may be a lack of sufficient discussion between patient and family physician on how to monitor and responsibly manage disease-related changes and exacerbations in daily life.
An emergency plan drawn up by the patient in collaboration with the attending physician that specifies the desired place of death and end of life treatment preferences could fill this gap and avoid unnecessary emergency responses and hospital admissions — but many patients reject this approach [ 30 , 31 ].
On the other hand, different patients may prefer different levels of information [ 32 ].
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