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End-stage heart failure patients in ICU: the importance of advance planning and effective communication

24 October 2024
Volume 33 · Issue 19

Abstract

During the disease trajectory, patients with advanced heart failure are often hospitalised with a high probability of admission to the intensive care setting. Using a case study, this article explores the care given to a patient with decompensated heart failure in an intensive care unit (ICU). It will discuss the significance of holistic assessment and effective symptom management, in particular the research related to breathlessness management. The importance of effective communication within the ICU multidisciplinary team, including with the patient/family will be explored, as the ICU environment can often lead to communication breakdown, patients being unable to voice their wishes and over-medicalisation. The effectiveness of early involvement of the palliative care team in ICU will be examined, including the use of tools such advance care planning and a treatment escalation plan and whether use of these can enable a better patient and family experience at the end of life. The role of palliative care champions will be discussed.

End-of-life (EoL) care remains a key focus in research, and it continues to pose challenges for patients, families and health professionals (Flannery et al, 2016). A report from the Parliamentary and Health Service Ombudsman (2015) emphasised poor communication and not identifying the needs of dying patients as two of the main elements criticised by families during EoL care. This is especially true for patients in the intensive care unit (ICU), as they are critically unwell, often sedated and unable to voice their wishes, therefore increasing the decision burden on the family (Wiegand et al, 2019). A worldwide study conducted by Avidan et al (2021) mentioned that 16–23% of patients who are receiving care in the ICU will die during their stay and more than 10% of all the admissions had limitations of life-sustaining therapies initiated during their stay.

This article will focus on an episode of EoL care of a patient in ICU with decompensated heart failure. Heart failure prevalence is rising every year and, in the UK, it is estimated that over half a million people live with the disease (Johnson et al, 2017). The discussion here will highlight the importance of a holistic care approach for patients and families, as well as the significance of having a treatment escalation plan and advance care plan in place when a patient's condition is deemed to have reached a stage where palliative rather than curative care is appropriate. The importance of effective and compassionate communication with the patient, family, and all members of the multidisciplinary team (MDT) involved in that episode of care will be examined. Earlier referral to the palliative care team and the role of palliative care champions will be explored. Finally, the importance of effective symptom management in EoL care will be discussed, focusing specifically on breathlessness management. Recommendations to improve patient and family experience will be addressed.

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