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Palliative care for cardiac failure
European Geriatric Medicine 2 (2011) 37
Introducing the case
Palliative care for cardiac failure A.J. Cruz-Jentoft * Servicio de Geriatria, Hospital Universitario Ramon y Cajal, Ctra. Colmenar km 9,100, 28034 Madrid, Spain
A R T I C L E I N F O
Article history: Available online 3 December 2010 Keywords: Palliative care Heart failure Elderly Health services
Mr. H. is a 79-year-old man, who has recently been admitted to the hospital for severe cardiac failure. He was a heavy smoker who only quitted last year, and suffers from hypertension and hypercholesterolemia. He had an anterior myocardial infarction 20 years ago and an inferior myocardial infarction 8 years ago. At that time coronary angiography was performed, showing severe three-vessel disease. A PTCA was done and a stent placed in the proximal right coronary artery. In the last five years he developed congestive heart failure, with three hospital admissions. One year ago an echocardiogram showed a severely dilated left ventricle with apical dyskinesia and a LV ejection fraction of 13%. In the last three months he has been admitted twice for severe grade IV heart failure, with long hospital stays. He is on perindopril, furosemide, nebivolol, spirolactone and nitrates. He has severe dyspnoea and frequent episodes of angina that are only partially controlled with sublingual nitrates. He lives with his 82-year-old wife, who suffers
severe osteoarthritis. He needs help for most of his basic ADL, only been able to eat by himself; he walks inside his home with the help of a cane and his wife, who has recently noticed some cognitive changes. Expert geriatricians from four different countries have been asked to explain how this patient will be cared for, what would be considered standard care in their country. They were asked to answer to some questions: Would a patient like this receive palliative care, or is palliative care reserved for cancer patients? Who will care for him? How will this be decided? Are objective criteria used to define final stages of non-cancer diseases amenable to end of life care? What kind of supportive treatment is offered? Which drugs used for symptom control? Are guidelines used for care? Is there any system to assess quality of end of life care of cardiac patients? What is the usual attitude of health care providers (physicians, nurses, aides) and caregivers/family members towards these patients? How are care decisions made? How is care provided in the hospital and after hospital discharge? How is follow-up performed? Are there mechanisms that may avoid hospital admissions without reducing quality of care?
Conflict of interest statement The author has no conflict of interest to declare.
* Tel.: +34 913368172; fax: +34 913368431. E-mail address: [email protected]. 1878-7649/$ – see front matter ß 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. doi:10.1016/j.eurger.2010.11.001
Introducing the case
Palliative care for cardiac failure A.J. Cruz-Jentoft * Servicio de Geriatria, Hospital Universitario Ramon y Cajal, Ctra. Colmenar km 9,100, 28034 Madrid, Spain
A R T I C L E I N F O
Article history: Available online 3 December 2010 Keywords: Palliative care Heart failure Elderly Health services
Mr. H. is a 79-year-old man, who has recently been admitted to the hospital for severe cardiac failure. He was a heavy smoker who only quitted last year, and suffers from hypertension and hypercholesterolemia. He had an anterior myocardial infarction 20 years ago and an inferior myocardial infarction 8 years ago. At that time coronary angiography was performed, showing severe three-vessel disease. A PTCA was done and a stent placed in the proximal right coronary artery. In the last five years he developed congestive heart failure, with three hospital admissions. One year ago an echocardiogram showed a severely dilated left ventricle with apical dyskinesia and a LV ejection fraction of 13%. In the last three months he has been admitted twice for severe grade IV heart failure, with long hospital stays. He is on perindopril, furosemide, nebivolol, spirolactone and nitrates. He has severe dyspnoea and frequent episodes of angina that are only partially controlled with sublingual nitrates. He lives with his 82-year-old wife, who suffers
severe osteoarthritis. He needs help for most of his basic ADL, only been able to eat by himself; he walks inside his home with the help of a cane and his wife, who has recently noticed some cognitive changes. Expert geriatricians from four different countries have been asked to explain how this patient will be cared for, what would be considered standard care in their country. They were asked to answer to some questions: Would a patient like this receive palliative care, or is palliative care reserved for cancer patients? Who will care for him? How will this be decided? Are objective criteria used to define final stages of non-cancer diseases amenable to end of life care? What kind of supportive treatment is offered? Which drugs used for symptom control? Are guidelines used for care? Is there any system to assess quality of end of life care of cardiac patients? What is the usual attitude of health care providers (physicians, nurses, aides) and caregivers/family members towards these patients? How are care decisions made? How is care provided in the hospital and after hospital discharge? How is follow-up performed? Are there mechanisms that may avoid hospital admissions without reducing quality of care?
Conflict of interest statement The author has no conflict of interest to declare.
* Tel.: +34 913368172; fax: +34 913368431. E-mail address: [email protected]. 1878-7649/$ – see front matter ß 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. doi:10.1016/j.eurger.2010.11.001