Abstract
Traditionally, patients with end-stage heart failure (HF) have rarely been involved in end-of-life care (EOLC) discussions in Japan. The purpose of this study was to examine the impact of HF-specific palliative care team (HF-PCT) activities on EOLC discussions with patients, HF therapy and care, and food intake at the end of life. We retrospectively analyzed 52 consecutive patients with HF (mean age, 70 ± 15 years; 42% female) who died at our hospital between May 2013 and July 2020 and divided them into two groups: before (Era 1, n = 19) and after (Era 2, n = 33) the initiation of HF-PCT activities in June 2015. Compared to Era 1, Era 2 showed a decrease in invasive procedures, an increase in opioid and non-intubating sedative use for symptom relief, improved quality of meals at the end of life, and an increase in participation in EOLC discussions. The administration of artificial nutrition in the final three days was associated with non-ischemic cardiomyopathy etiology, the number of previous hospitalizations for HF, and multidisciplinary EOLC discussion support. HF-PCT activities may provide an opportunity to discuss EOLC with patients, reduce the burden of physical and psychological symptoms, and shift the goals of end-of-life nutritional intake to ensure comfort and quality of life.
Highlights
Recent developments in new drugs, monitoring systems, and device therapies have evolved heart failure (HF) therapy; these developments may stabilize HF but rarely cure it
Nineteen patients who died during Era 1 and 33 patients who died during Era 2 were included in the analyses
There were no significant differences in demographics or clinical characteristics between the two groups, except for the etiology of Duration of HF, months
Summary
Recent developments in new drugs, monitoring systems, and device therapies have evolved heart failure (HF) therapy; these developments may stabilize HF but rarely cure it. These advances are often only available for a limited number of patients. Traditionally in Japan, patients rarely participate in discussions about their own goals and preferences for end-of-life care (EOLC), because their families may hesitate to bring bad news. As patients tend to lose their decision-making ability toward the end of life [5], they sometimes have no opportunity to express their wishes and preferences regarding their EOLC. In patients with end-stage HF, the goal of nutritional care is to optimize quality of life and comfort
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