Angels Grace Hospice, Illinois

Heart failure and hospice care- a discussion at end of life

In order to understand the care that is required for an individual diagnosed with End Stage heart failure or CHF (Congestive Heart Failure), one must understand the disease process itself.  If one has been diagnosed with heart failure, it means one’s heart is no longer pumping strong enough throughout your body.  Heart failure can affect the right side, the left side, or both sides of the heart.  Left sided heart failure is more common. Both types increase the risk of the same types of complications of heart failure. Some of the most common complications include: Irregular heart beat which can lead to the heart pumping at a less efficient, faster rate which can in turn lead to clots forming. With clots, one runs the risk of developing a stroke, heart attack, or pulmonary embolism. Another complication can include heart valve issues.  Heart failure can change the size of your heart making it larger which in turn places pressure on the four valves of the heart that moves the blood in and out of the chambers within it.  Over time, this effects how the valves work.  If the heart is strained, it can no longer to an effective nor efficient pump, therefore other organs so not receive the oxygenated blood as they once did which can cause damage to both the kidneys and liver.  If the kidneys don’t function, and individual may need dialysis.  If the liver doesn’t function, the body can build with toxins and cause its own set of problems. The entire body depends on the heart to pump oxygenated blood to the major organs in order to allow them to function at their best capacity, but in the case of heart failure, this does not happen.

So what does it mean when my doctor tells me I have End Stage Heart failure?

When someone is told they are at the end stage of heart failure, it usually is after many years of treatment of managing a variety of symptoms.  Depending on the type of heart failure one has, symptoms can vary in type and intensity.  Edema (fluid collection and swelling), shortness of breath, fluid in the lungs, and activity intolerance are common symptoms that people experience.  As mentioned above, as the condition worsens and the heart becomes weaker, the other major body systems begin to suffer.  At this stage of the disease process, it almost becomes a balancing act to keep the body’s major organs in balance for optimal functioning.  For example,  if the patients diuretic medications are increased to help with fluid collection in the extremities and or lungs, this in turn can cause the kidneys to not be able to function and may cause kidney failure resulting in the need of dialysis.  Hospice care is mentioned when it is no longer feasible to balance the body’s varying symptoms without causing a catastrophic effect. 

So I have entered into hospice care due to my poor prognosis with heart failure, what does that mean?

The time has come when it is no longer feasible to be able to balance the multisystem failures that the body is going through as a result of a failing heart.  In hospice, through the team of experienced nurses and medical directors, the individual can expect a specific plan of care to be developed to meet their individual needs. The focus turns from long term care and interventions to comfort care as the main goal.  Symptom management is of the upmost importance to provide an individual comfort and dignity during this time.  Stress and fear of the  unknown are common for both patients and their families during this time.  This is where our interdisciplinary team work together to stay on top of symptoms like shortness of breath, swelling, pain, anxiety etc. through medical interventions, spiritual support, and education.  Often it is asked, will the team be honest with my loved one and myself as a family member as we go through this process, and the simple answer is yes.  As symptoms and changes occur throughout the transitioning process, team members will be respectful, educational, and honest as far as the progression of the disease process.  The interventions are explained and the rationale why such interventions are deemed beneficial for the individual and the expected outcome.  The plan of care is ever changing as the patient changes, to ensure comfort and respect.  The key is taking the individuals case and tailoring the plan or care to his or her specific needs.  Through interventions of supplemental oxygen, medications for shortness of breath, pain relieving medications, and medications for anxiety, as a team we are able to establish a successful means of controlling troublesome symptoms. At Angels Grace Hospice, our goal is to provide comfort, support, and education for our patients and their families in which we serve.