CARDIAC INSUFFICIENCY AND PALLIATIVE CARE: ACTIVE CARE COMPONENT

CARDIAC INSUFFICIENCY AND PALLIATIVE CARE: ACTIVE CARE COMPONENT

 

Previously: Heart failure and palliative care (support therapy)

 

5 important components are treated:

  • A recall on heart failure and so-called active treatment;
  • An individualized action plan;
  • Supportive care and accompaniment, in addition to so-called active therapy;
  • Imminent end of life;
  • End-of-life care

 

The heart, the motor for all circulation

The muscular pump known as the heart provides oxygen and nutrients to all cells of the body. At the same time, the circulation eliminates the toxic elements produced by these same cells.

 

When the pump of our blood circulation is ineffective

When this pump can no longer do its job, toxic elements accumulate and different organs, such as the kidneys and the liver, are less effective. Fatigue increases and the brain works slower.

 

Read more: Understanding Heart Failure

 

The effects of this insufficiency

In patients with terminal heart failure, and even more at the end of life, the patient may be particularly exhausted, depressed and demoralized, and may feel out of breathe even at rest and at night.

The quality of life of an end-of-life heart failure is therefore, in some cases, considerably less than that of a patient at the same stage of life and suffering from cancer.

 

Standard treatment phase: active therapy

The description of active care refers to the various specific treatments that aim to improve the quality of life of patients daily and significantly extend their longevity.

Active therapy has two elements that always go hand-in-hand.

On one hand, there is the pharmaceutical therapy, or a treatment consisting of pills to be taken regularly.

 

The combination of these drugs varies from one patient to another:

• Angiotensin Converting Enzyme (ACEI) inhibitors, Renin-Agiotensin Antagonist (ARB) or Entresto;

• beta-blockers;

• diuretics;

• ivabradine.

 

To know more: Pharmaco-component for each class

 

On the other hand, the non-pharmaceutical part is composed of elements related to lifestyle in addition to other possible interventions such as the introduction of a cardiostimulator type Bi Ventricular (Bi-V). 

 

These elements include:

• limited fluid consumption (1.5 to 2 liters per day);

• a diet without salt;

• regular monitoring of body weight;

• vaccination against influenza and pneumonia;

• blood pressure checkups.

 

Other elements are also to watch. We find among others:

• anemia;

• deterioration of kidney function;

• hyperthyroidism (a thyroid gland that works in fast motion);

• a rhythm disorder;

• falls in blood pressure.

 

The notion of quality of life varies from person to person

The definition of quality of life differs considerably from one patient to another. It also varies throughout the course of the disease.

The progressive limitations of their illness make them adapt to their new condition and become more lucid about their expectations of life although they see themselves slowly deteriorate.

Their condition now makes them say: "I’m not doing that anymore, I leave it to the others" or again: "I can’t do that anymore".

 

To accompany

A multidisciplinary team accompanies a patient with heart failure. Several resource people give the patients the tools needed to improve the quality of life, or even extend it.

Heart Failure Clinics (CLICs) are valuable resources for physicians unfamiliar with this type of problem; they are better equipped tomonitor more seriously affected patients

 

Read more: Heart failure and supportive therapy: individualized action plan