- Email: [email protected]
Palliative Medicine for Elderly Patients with Chronic Heart Failure: Role of a Physical Therapist
S112 Journal of Cardiac Failure Vol. 19 No. 10S October 2013
Joint Symposium 3 JSY3-1 Renovating Terminal Care with Urban-type Home Healthcare for Heart Failure DAI YUMINO1,2, NORIKI ITO1, TAKUYA FUKASAWA1, TAKAKO MIYAZAKI1, MAKI YOSHIDA1, HIDEO HORIBE1, TSUYOSHI SHIGA2, NOBUHISA HAGIWARA2 1 Cardiology, Yumino Heart Clinic, 2Department of Cardiology, Tokyo Women’s Medical University Management of the end-of-life for terminal heart failure patients is going to be one of crucial issues in cardiovascular medicine. There exists a twisted structure where home doctor of a patient is often in either university hospital or general hospital instead of general practitioners especially in urban area with many advanced medical institutions. As a result, heart failure patients who repeatedly admitted to a hospital are often transported to those advanced medical institutions and result in long hospital stay. This phenomenon could be explained by the imbalance of the drastic increase in the number of terminal heart failure patients to the system to support and provide home healthcare for elderly heart failure patients who are often characterized by living alone, have dementia, and suffer from many other complications. I believe the current system must be changed by shifting the focus on the prevention of repeated hospitalization, on management at home instead of long hospital stay, and on providing terminal care in collaboration with advanced medical institutions along with inter-professional collaboration of healthcare professionals. In this session, we will introduce our home healthcare service for terminal heart failure patients and would like to discuss and pursue the possibility whether our activities could revolutionize the current heart failure medicine.
JSY3-2 Clinical Pathway between Medical and Nursing Institutes Develops Regional Partnership Supporting People with Heart Disease in North Shinshu NOBORU WATANABE Cardiovascular Medicine, Hokushin General Hospital Chronic heart failure (CHF) becomes critical disease in aging of the population. Conventional treatment for CHF is not enough and resulted in recurrent exacerbating conditions. To improve these managements, we developed regional partnership between medical and nursing institutions. Our hospital is a center hospital in North Shinshu area with about 100,000 populations. We were collaborating closely with the local medical associations and made a path-sheet for both clinical program and information provision between the hospital and neighboring clinics. In hospital co-medical team cooperated with local public health nurse with comprehensive co-medical clinical path-sheet. We have started the path from February 2009 and followed up over 150 patients with CHF to June 2013. Over 25% of the patients dropped out from the path. Most of the reasons were other than CHF condition, for problems of social and family care, or reducing physical activities. We established the regional partnership council to promote and provide these actions across the local area or multi-category of business, industry, institute and government. Main subjects are building communication and education network system for family and staff members, and supporting living resources to keep physical activities and diet therapy for CHF patients. The members of the council cross over category of works and collaborate each other to help peoples own life with cardiovascular disease at home.
JSY3-3 Management of the Patients with Chronic Heart Failure; the Role for Nurses and Team Management YUKI TSUJII Department of Nursing, Himeji Cardiovascular Center Congestive heart failure (CHF) is a chronic, debilitating illness while repeated exacerbations and remissions. Thus the onset of advanced CHF is not a sudden event and characterizes as a part of the gradual deterioration, the possibility that end stage of CHF has been reached should always be considered if a patient’s condition appears to be static or deteriorating despite the maximum tolerated guideline-based medication. At this pivotal stage in patient management, appropriate levels of symptomatic relief, support, and palliative care for patients with advanced CHF should be addressed as a main component of the plan of care. Here we presented a case of young patient with end stage CHF of the 40’s whom we’ve been care for 10 years and demonstrated the consideration of the timing to start palliative care and how to indicate palliative care. As a heart failure specialist nurses, we effectively optimized and monitored patients’ medication and adjusted the timing to visits to reduce high incidence of rehospitalisation coping with patients’ problems individually.
Advance care planning provides the patients and their family with an opportunity to consider, discusses, and plan his future care with health professionals. On this basis we should take on the key role of co-ordinating patient management across the hospital/clinic care boundary thus facilitating the implementation of this important component of the ACP.
JSY3-4 Palliative Medicine for Elderly Patients with Chronic Heart Failure: Role of a Physical Therapist KENTARO KAMIYA Rehabilitation Center, Kitasato University Hospital Palliative medicine is aimed at improving quality of life and supporting patients and their families. Maintaining functional independence is a high priority for elderly patients with chronic heart failure. According to our previous survey, more than half of the elderly patients with acute decompensated heart failure had walking problems. In such patients, quadriceps strength and balance function play important roles in maintaining functional independence. We analyzed the relationship between quadriceps strength and balance function, which was measured by a short physical performance battery (SPPB), and walking function in 621 patients with cardiac disease. Multivariate regression analysis showed that the quadriceps strength and balance function were the strongest predictors of exercise capacity and walking independence. The critical cut-off value for walking independence was $10 in the SPPB score. Receiver operating characteristic curves identified that isometric quadriceps strength of 45% and 50% body weight is required to achieve exercise capacities of 5 and 7 metabolic equivalents, respectively. Quadriceps strength and SPPB could be indicators of functional independence. Elderly patients presenting with very low percentiles with respect to their quadriceps strength or SPPB assessment may require timely referral to palliative care services.
JSY3-5 Home Assistance (Multidisciplinary Cooperation) MAKIKO OSHIKAWA Care Division, Half Century More Japan has entered an aging society, and the number of patients with heart failure, especially elderly people, is on the rise, and they have been repeatedly hospitalized. In this current state, what kind of support system can be built focusing on long-term care insurance becomes important in order to support care-giving at home. Among these, it is thought that the key is the direction of care managers in tight multidisciplinary collaboration with parties such as doctors, visiting nurses, nursing care and rehabilitation. Home palliative care focusing on the role of visiting nurses and care managers will be discussed here.
Joint Symposium 3 JSY3-1 Renovating Terminal Care with Urban-type Home Healthcare for Heart Failure DAI YUMINO1,2, NORIKI ITO1, TAKUYA FUKASAWA1, TAKAKO MIYAZAKI1, MAKI YOSHIDA1, HIDEO HORIBE1, TSUYOSHI SHIGA2, NOBUHISA HAGIWARA2 1 Cardiology, Yumino Heart Clinic, 2Department of Cardiology, Tokyo Women’s Medical University Management of the end-of-life for terminal heart failure patients is going to be one of crucial issues in cardiovascular medicine. There exists a twisted structure where home doctor of a patient is often in either university hospital or general hospital instead of general practitioners especially in urban area with many advanced medical institutions. As a result, heart failure patients who repeatedly admitted to a hospital are often transported to those advanced medical institutions and result in long hospital stay. This phenomenon could be explained by the imbalance of the drastic increase in the number of terminal heart failure patients to the system to support and provide home healthcare for elderly heart failure patients who are often characterized by living alone, have dementia, and suffer from many other complications. I believe the current system must be changed by shifting the focus on the prevention of repeated hospitalization, on management at home instead of long hospital stay, and on providing terminal care in collaboration with advanced medical institutions along with inter-professional collaboration of healthcare professionals. In this session, we will introduce our home healthcare service for terminal heart failure patients and would like to discuss and pursue the possibility whether our activities could revolutionize the current heart failure medicine.
JSY3-2 Clinical Pathway between Medical and Nursing Institutes Develops Regional Partnership Supporting People with Heart Disease in North Shinshu NOBORU WATANABE Cardiovascular Medicine, Hokushin General Hospital Chronic heart failure (CHF) becomes critical disease in aging of the population. Conventional treatment for CHF is not enough and resulted in recurrent exacerbating conditions. To improve these managements, we developed regional partnership between medical and nursing institutions. Our hospital is a center hospital in North Shinshu area with about 100,000 populations. We were collaborating closely with the local medical associations and made a path-sheet for both clinical program and information provision between the hospital and neighboring clinics. In hospital co-medical team cooperated with local public health nurse with comprehensive co-medical clinical path-sheet. We have started the path from February 2009 and followed up over 150 patients with CHF to June 2013. Over 25% of the patients dropped out from the path. Most of the reasons were other than CHF condition, for problems of social and family care, or reducing physical activities. We established the regional partnership council to promote and provide these actions across the local area or multi-category of business, industry, institute and government. Main subjects are building communication and education network system for family and staff members, and supporting living resources to keep physical activities and diet therapy for CHF patients. The members of the council cross over category of works and collaborate each other to help peoples own life with cardiovascular disease at home.
JSY3-3 Management of the Patients with Chronic Heart Failure; the Role for Nurses and Team Management YUKI TSUJII Department of Nursing, Himeji Cardiovascular Center Congestive heart failure (CHF) is a chronic, debilitating illness while repeated exacerbations and remissions. Thus the onset of advanced CHF is not a sudden event and characterizes as a part of the gradual deterioration, the possibility that end stage of CHF has been reached should always be considered if a patient’s condition appears to be static or deteriorating despite the maximum tolerated guideline-based medication. At this pivotal stage in patient management, appropriate levels of symptomatic relief, support, and palliative care for patients with advanced CHF should be addressed as a main component of the plan of care. Here we presented a case of young patient with end stage CHF of the 40’s whom we’ve been care for 10 years and demonstrated the consideration of the timing to start palliative care and how to indicate palliative care. As a heart failure specialist nurses, we effectively optimized and monitored patients’ medication and adjusted the timing to visits to reduce high incidence of rehospitalisation coping with patients’ problems individually.
Advance care planning provides the patients and their family with an opportunity to consider, discusses, and plan his future care with health professionals. On this basis we should take on the key role of co-ordinating patient management across the hospital/clinic care boundary thus facilitating the implementation of this important component of the ACP.
JSY3-4 Palliative Medicine for Elderly Patients with Chronic Heart Failure: Role of a Physical Therapist KENTARO KAMIYA Rehabilitation Center, Kitasato University Hospital Palliative medicine is aimed at improving quality of life and supporting patients and their families. Maintaining functional independence is a high priority for elderly patients with chronic heart failure. According to our previous survey, more than half of the elderly patients with acute decompensated heart failure had walking problems. In such patients, quadriceps strength and balance function play important roles in maintaining functional independence. We analyzed the relationship between quadriceps strength and balance function, which was measured by a short physical performance battery (SPPB), and walking function in 621 patients with cardiac disease. Multivariate regression analysis showed that the quadriceps strength and balance function were the strongest predictors of exercise capacity and walking independence. The critical cut-off value for walking independence was $10 in the SPPB score. Receiver operating characteristic curves identified that isometric quadriceps strength of 45% and 50% body weight is required to achieve exercise capacities of 5 and 7 metabolic equivalents, respectively. Quadriceps strength and SPPB could be indicators of functional independence. Elderly patients presenting with very low percentiles with respect to their quadriceps strength or SPPB assessment may require timely referral to palliative care services.
JSY3-5 Home Assistance (Multidisciplinary Cooperation) MAKIKO OSHIKAWA Care Division, Half Century More Japan has entered an aging society, and the number of patients with heart failure, especially elderly people, is on the rise, and they have been repeatedly hospitalized. In this current state, what kind of support system can be built focusing on long-term care insurance becomes important in order to support care-giving at home. Among these, it is thought that the key is the direction of care managers in tight multidisciplinary collaboration with parties such as doctors, visiting nurses, nursing care and rehabilitation. Home palliative care focusing on the role of visiting nurses and care managers will be discussed here.