In May 2017 Hospice UK and the British Heart Foundation, in collaboration with the new Wolfson Palliative Care Research Centre at the University of Hull, produced a joint publication, Heart failure and hospice care: How to make a difference. The report showed that whilst more than 60,000 people die of heart failure each year in the UK, only around four per cent are supported by specialist palliative care and hospice teams.
Wigan and Leigh Hospice is focussing its 2018 conference on this issue. The conference, At the heart of the matter – palliative care and heart failure, will take place on May 11 at Leigh Sports Village, Greater Manchester.
It is generally recognised that heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. It seems that communication about prognosis and death for people with heart failure is intrinsically more complicated than it is for someone with other life-limiting conditions, such as cancer. Heart failure patients often have little insight into the nature of their disease or their prognosis, and rarely initiate or are offered discussions on end-of-life issues with their professional carers (Tiny et al 2009)1.
Hauser and Bonow (2012)2 discuss how many of the symptoms experienced by the patient with heart failure are similar to those experienced by the patient who has a cancer diagnosis. These are symptoms such as shortness of breath, pain and fatigue. These multiple symptoms also sit alongside co-existing conditions, as they do with the patient with cancer.
The issue of ensuring heart failure patients receive palliative care is something that depends on local arrangements between specialist palliative care providers, primary care organisations, and the heart failure team. Between them, they should provide supportive and palliative care for the patient and carers.
Gibbs et al (2002)3 highlights how mental health problems have also been largely overlooked in heart failure patients which can lead to significant psychological distress. In particular, depression is common. Depression has been shown to increase the hospital readmission rate of patients with heart failure as well as causing a significant increase in mortality. Additionally, depression could result in poor patient compliance with medication and a failure to seek medical help at an appropriate time.
The one-day conference organised by Wigan and Leigh Hospice will examine the interface between palliative care and heart failure patients, and how acute, community and hospice teams can work together to provide the best and most appropriate care. Speakers including Professor Miriam Johnson, Professor of Palliative Medicine at the Wolfson Palliative Care Research Centre, will discuss current practice, the prevalence of depression and explore how beneficial advance care planning is to this particular group of patients.
The specialist nursing team at the hospice has been involved in joint working with the local NHS community heart failure team for over ten years to ensure that heart failure patients access palliative care, carrying out joint visits and assessments and providing additional training and advice in aspects of palliative care including symptom management, addressing psychological or spiritual needs and advance care planning. GPs, district nurses and community services are also encouraged to refer any patients who are in the last year of life to the hospice for assessment and support if required.
1. Tiny et al, (2009) Palliative Care in Heart Failure: A Position Statement from the Palliative Care Workshop of the Heart Failure Association of the European Society of Cardiology, Scientific IRCCS Network
2. Hauser. T, Bonow. R, (2012) Heart Failure and Palliative Care, Heart Failure, 2nd Edition
3. Gibbs et al (2002) Living with and dying from heart failure; the role of palliative care, British Medical Journal, Vol 88, issue supplement 2