Palliative care for heart disease patients

People living with heart failure have similar symptoms and levels of depression and spiritual well-being as patients with advanced lung and pancreatic cancer.

Dr. David Bekelman from the University of Colorado Denver School of Medicine thinks, “Perhaps we can do more to reduce [this] burden for heart failure patients.”

First, the details.

• 60 heart failure patients were compared to 30 patients with advanced cancer.
• The patients were not hospitalized, and were able to attend clinics and complete questionnaires.

And, the results.

• Symptom severity, depression, and spiritual well-being were similar for both groups of patients.
• However, the patients with the most advanced heart-failure were significantly worse off, with respect to these symptoms compared to those with cancer.
• Remember, they were very ill but not bedridden.

The bottom line?
Patients with heart failure appear to have a similar (or greater) burden of symptoms, depression, and low levels of spiritual well-being compared to advanced cancer patients. Yet, they are less likely to receive care directed at these symptoms, according to Dr. Bekelman.

During an interview with Medscape, he noted there are a lot of ups and downs with heart disease. The patients can die at any time from sudden cardiac death, or they can enter the hospital critically ill and then sometimes recover. “That’s a major illness-related barrier to providing palliative care.”

“Depression, which is common in patients with heart failure, can be treated with medications and counseling. Persistent symptoms can also contribute to depression, and treating persistent symptoms can help improve mood,” advises Dr. Bekelman.

He recommends to “not underestimate the importance of using supportive communication and empathy with heart failure patients to reduce both symptoms and depression.”

Why not get a chaplain or clergy member involved in the patient’s care to improve spiritual well-being? Other options to improve spiritual well-being include dignity therapy and meaning-centered psychotherapy.

There seems to be a trend toward making palliative care an options for patients who are not at the end of life. Read more here about patients with lung disease, and here about people with chronic pain.

5/9/08 22:00 JR