Palliative Care in Advanced Heart Failure: The Experience of an Intra-Hospital Support Palliative Care Team

Abstract

Introduction: Heart failure develops in most chronic heart diseases, and is associated to high morbidity and mortality, as
well as poor quality of life. In advanced stages, patients benefit from an integrated approach from palliative care. This study
aimed to evaluate the intervention of an Intra-Hospital Support Palliative Care Team (IHSPCT) in hospitalized patients
with advanced heart failure, identifying the main needs and
areas of action.
Material and Methods: Retrospective analysis of clinical records from hospitalized patients with heart failure in a university hospital within the first five years of IHSPCT.
Results and Discussion: Sixty patients were evaluated, 0.5%
(n = 12007) of the total heart failure hospitalized patients in that
period, with 41.5% (n = 25) 30-days survival. The main criteria for collaboration regarded needs in controlling symptoms
(83.3%, n = 50) and discharge care organization (83.3%, n = 50).
Dyspnea was the most prevalent not controlled symptom
(75.0%, n = 45). IHSPCT intervention occurred at therapeutic
level, with pharmacological intervention in almost all patients
(88.3%, n = 53) and non-pharmacological in 46.7% (n = 28);
43.3% (n = 26) of the patients required a family conference
and the same number of patients required a direct approach
by Social Service, 5.0% (n = 3) of the patients were submitted to a psychological / psychiatric intervention. Support was
also required for decision-making in diverse situations such
as therapeutic suspension or food issues.
Conclusion: This advanced heart failure group of patients
confirmed complex palliative needs due to high symptomatic
load and due to the diversity of interventions required.