Chapter

End of life

Miriam Johnson

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0055

Series: Oxford Textbooks

End of life

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The clinical course of heart failure (HF) has been transformed bythe development of therapies (medication, devices, and surgery)targeted at the pathophysiological mechanisms underlying itsperpetuation and progression. Over the last decade, the prognosishas improved and it is likely that the 1-year survival figures often quoted are now less bleak. However, given that HF is a progressivedisease, patients who have not suffered a sudden cardiac deathfrom arrhythmia ultimately enter an end stage which may be prolonged, and carries a significant daily symptom burden, affectingboth themselves and their caregivers. With increasing use of implantable defibrillators, more patients may eventually live toexperience such endstage disease. In addition, comorbidities, oftensmoking related, are common. Comorbidities add to the symptomload, affect optimum cardiac management, and may be the finalcause of death.End-of-life care is not always delivered well, particularly in secondarycare settings where the emphasis may still be on life-prolonginginterventions. The dying phase may not be recognized oracknowledged. Despite Hinton’s observations 50 years ago thatpatients with HF and renal failure often died in distress, those withnonmalignant disease still have unequal access to services skilled inend-of-life care; more than 95% of patients seen by hospice servicesin the United Kingdom have cancer. In the United Kingdom, theDepartment of Health has declared end-of-life care to be a national priority. To this end, a national End of Life Strategy is to be implementedthroughout the National Health Service, and tools suchas the Liverpool Care of the Dying Pathway (LCP) and the GoldStandards Framework (GSF) have been recommended. Such acentral drive is welcome, but several challenges remain in the careof the patient dying from HF; the main one being the difficultiesclinicians, patients, and their carers may have in recognizing theend stage of the illness.

Chapter.  7831 words. 

Subjects: Cardiovascular Medicine

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