Staging of heart failure in patients is achieved through two measures, an assessment of the patient’s symptoms as well as an objective assessment. The most severe of these two classifications Stage IV D can be described as an inability to perform any physical activity without discomfort and ‘objective evidence of severe cardiovascular disease’ (American Heart Association, 2015). There are difficulties in providing optimal care in these patients and this is due in part to the rate of decline in end stage heart failure which often follows a pattern of unpredictable improvements and declines with an overall subtle decline in baseline function (Adler, Goldfinger, Kalman, Park, & Meier, 2009). It is this characteristic of heart failure which can
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The management and titration of these therapies in the late stages of heart failure require the need to balance the adverse effects of these therapies against the therapeutic benefit. There is also a need to manage the tablet burden of patients in the end stages of the disease and life, there is a strong component of patient choices in this regard with a need for good communication and patient understanding of their prognosis. Interestingly whilst heart disease is not commonly regarded as a painful condition, many patients will experience pain as a result of the condition and indeed pain management is often the top concern of patients (Adler et al., 2009; Johnson, …show more content…
Until recently heart disease has not been considered a terminal illness and it has lacked the multidisciplinary support of many other terminal conditions, this has led in many cases to inadequate management of end of life care in these patients as seen in studies in patients and bereaved caregivers. Communication is a critical component of providing this end of life care, and optimizing communication between patient and medical staff, as well as between patient and relatives is essential to ensure that the ongoing care manages the patient’s symptoms and expectations. These expectations may change at the very end of life when the patient is no longer able to contribute to decisions about their care, so a good knowledge of the patients wishes prior to this is
The management and titration of these therapies in the late stages of heart failure require the need to balance the adverse effects of these therapies against the therapeutic benefit. There is also a need to manage the tablet burden of patients in the end stages of the disease and life, there is a strong component of patient choices in this regard with a need for good communication and patient understanding of their prognosis. Interestingly whilst heart disease is not commonly regarded as a painful condition, many patients will experience pain as a result of the condition and indeed pain management is often the top concern of patients (Adler et al., 2009; Johnson, …show more content…
Until recently heart disease has not been considered a terminal illness and it has lacked the multidisciplinary support of many other terminal conditions, this has led in many cases to inadequate management of end of life care in these patients as seen in studies in patients and bereaved caregivers. Communication is a critical component of providing this end of life care, and optimizing communication between patient and medical staff, as well as between patient and relatives is essential to ensure that the ongoing care manages the patient’s symptoms and expectations. These expectations may change at the very end of life when the patient is no longer able to contribute to decisions about their care, so a good knowledge of the patients wishes prior to this is