Upstreaming palliative care for patients with heart failure.

Upstreaming palliative care, practicing and advocating for palliative care earlier in the heart failure (HF) trajectory, is an idea whose time has come. In this article, we explore the meaning of palliative care for HF and then discuss its relationships with both chronic care and end-of-life care. A case study is used to envision the practical implementation of palliative care into existing systems of care. We conclude by discussing the clinician's role in implementing palliative care earlier for individuals with HF by practice and advocacy.

Comparison of prevalence of symptoms of depression, anxiety, and hostility in elderly patients with heart failure, myocardial infarction, and a coronary artery bypass graft.

OBJECTIVE: This study sought to compare the prevalence of anxiety, depression, and hostility among 3 clinically diverse elderly cardiac patient cohorts and a reference group of healthy elders. METHODS: This was a multicenter, comparative study. A total of 1167 individuals participated: 260 healthy elders, and 907 elderly cardiac patients who were at least 3 months past a hospitalization (478 heart-failure patients, 298 postmyocardial infarction patients, and 131 postcoronary artery bypass graft patients). Symptoms of anxiety, depression, and hostility were measured using the Multiple Affect Adjective Checklist. RESULTS: The prevalence of anxiety, depression, and hostility was higher in patients in each of the cardiac patient groups than in the group of healthy elders. Almost three quarters of patients with heart failure reported experiencing symptoms of depression, and the heart-failure group manifested the greatest percentage of patients with depressive symptoms. CONCLUSIONS: The high levels of emotional distress common in cardiac patients are not a function of aging, because healthy elders exhibit low levels of anxiety, depression, and hostility.

A comparison of health-related quality of life between older adults with heart failure and healthy older adults.

BACKGROUND: Health-related quality of life (HRQOL) in older adults with heart failure may be affected by a variety of variables including aging. It is important to determine the unique impact of heart failure to more effectively improve HRQOL in this population. OBJECTIVE: The purpose of this study was to compare HRQOL and physical, psychologic, clinical, and sociodemographic status in older adults with and without heart failure. METHODS: The HRQOL of 90 older adults with heart failure and 116 healthy older adults was compared. The factors best associated with HRQOL in each group were determined using multiple regression model. RESULTS: HRQOL was substantially worse among older adults with heart failure than among healthy older adults. Older adults with heart failure had more severe physical and emotional symptoms, poorer functional status, and worse health perceptions. Physical symptom status was the strongest predictor of HRQOL in both groups. In addition, in older adults with heart failure, physical symptom status, age, and anxiety were related to HRQOL. CONCLUSION: The poor HRQOL seen in patients with heart failure is not just a reflection of aging. Comprehensive interventions targeted toward the factors that specifically negatively impact HRQOL are essential in older adults with heart failure.

Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure.

A lack of comprehensive and effective palliative care is clearly evident in a number of studies describing the end of life for patients with advanced heart failure. These patients have been portrayed as experiencing a wide array of poorly managed symptoms. The primary rationale for the lack of care has been the uncertain illness trajectory that characterizes living with advanced heart failure. Nurses must manage care beyond the illness trajectory from an emphasis of palliative care as each of these patients may face significant illness burden and even sudden death. The purpose of this paper is to: discuss the current status of palliative care for patients with advanced heart failure; explain the basic pathophysiology and resulting signs and symptoms of advanced heart failure; describe pharmacological and non-pharmacological symptom management strategies for patients with advanced heart failure.

Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure.

BACKGROUND: Heart failure is an escalating health problem around the world. Despite significant scientific advances, heart failure patients experience multiple physical and psychological symptoms that can impact the quality of life. AIMS: To determine the (1) symptom prevalence, severity, distress and symptom burden in patients with heart failure; (2) impact of age and gender on symptom prevalence, severity, distress and symptom burden; and (3) impact of symptom prevalence and symptom burden on health-related quality of life (HRQOL) in patients with heart failure. METHODS: A convenience sample of 53 heart failure patients participated in this descriptive, cross-sectional design. Symptoms and HRQOL were measured using the Memorial Symptom Assessment Scale-Heart Failure and the Minnesota Living with Heart Failure Questionnaire. RESULTS: Patients experienced a mean of 15.1+/-8.0 symptoms. Shortness of breath and lack of energy were the most prevalent. Difficulty sleeping was the most burdensome symptom. Lower age, worse functional status, total symptom prevalence and total symptom burden predicted 67% of the variance in HRQOL. CONCLUSION: Patients with heart failure experience a high level of symptoms and symptom burden. Nurses should target interventions to decrease frequency, severity, distress and overall symptom burden and improve HRQOL.

Patients with heart failure who die in hospice.

BACKGROUND: Patients with end-stage heart failure experience disability, dyspnea, pain, and suffering at the end of life despite progress in treatment approaches. Little is known about the patients with heart failure in hospice and the impact of hospice care on health-related outcomes. METHODS AND RESULTS: The purposes of this retrospective, descriptive chart review were to (1) describe the characteristics of patients who receive hospice care, (2) identify symptoms most commonly reported by patients with heart failure in hospice during the last 7 days of life, and (3) identify interventions used by hospice nurses to manage the symptoms. The majority of the patients were women, widowed, and white. Median length of stay was 10 days. Nearly 37% of the patients were admitted to hospice during the last week of life. Primary symptoms at admission for hospice care included dyspnea, confusion at least some of the time, and poor appetite. There was no statistically significant difference in symptoms between the day of admission for hospice care and the day of death. Symptom management strategies included oxygen, family reassurance or education, skin care, and patient education. Medications commonly used to relieve symptoms included antianxiety medications, morphine, and/or other narcotics. Although mainstay heart failure drugs had been prescribed for some patients, prescription rates were low and not in line with current guideline recommendations, nor were those medications recorded as being used for symptom management. CONCLUSION: Further research including prospective study is needed to clearly articulate the impact of hospice care on patients and families affected by heart failure.

Faculty role transition from a community college to a research-intensive university.

Transitions between academic settings require new faculty members to develop expertise consistent with the institutions' specific missions. Even those faculty members considered experts in their field must adapt to the challenges of new work settings. In nursing education, mentoring has been shown to address many of those challenges. This article describes the changes in nursing faculty roles involved in a transition from a community college to a research-intensive university within the same urban setting but with different missions. In addition, we propose strategies for facilitating those changes through the use of internal and external mentors. The university setting can provide an almost unlimited environment for professional growth, and internal and external mentors can provide the support crucial to successful transition.

Qualitative analysis of living with heart failure.

BACKGROUND: The incidence of heart failure has been described as epidemic in proportion. Although literature abounds surrounding issues of epidemiology, pathophysiology, and treatment issues for those with heart failure, little is known about the day-to-day experiences of adults living with this chronic illness. OBJECTIVES: The purpose of this study was to describe and analyze the experience of adults who are living with heart failure. The specific aims were to describe the problems, challenges, and processes of living with heart failure, to identify strategies and tactics adults use to live with heart failure, and to provide a model that articulates what the participants described. METHODS: Principles of naturalistic inquiry were used to describe problems, challenges, and processes of living with heart failure. Six women and 5 men participated in in-depth interviews that lasted from 40 minutes to 100 minutes. Data were collected and analyzed with the constant, comparative method. RESULTS: Participants' use of language referring to wind and water in describing their heart failure symptoms led to discovery of navigating and aspects of navigational science as metaphors for living with heart failure. The 3 main categories of the resulting model were called experiencing turbulence, navigating, and finding safe harbor. CONCLUSIONS: Use of the model for living with heart failure may provide for creation of interventions for adults to improve their ability to manage their own care in the face of this potentially devastating illness.