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2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3529=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(106)||chr(107)||chr(118)||chr(113)||(select (case when (3529=3529) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(98)||chr(113)||chr(113)||chr(62))) from dual)-- fhnu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 order by 1-- gmoi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 4949=utl_inaddr.get_host_address(chr(113)||chr(106)||chr(107)||chr(118)||chr(113)||(select (case when (4949=4949) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(98)||chr(113)||chr(113))-- ktgp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (8036=8036) then null else cast((chr(109)||chr(65)||chr(84)||chr(72)) as numeric) end)) is null-- zkzl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3409=concat(char(113)+char(106)+char(107)+char(118)+char(113),(select (case when (3409=3409) then char(49) else char(48) end)),char(113)+char(106)+char(98)+char(113)+char(113))-- diyj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (5528=2881) then null else ctxsys.drithsx.sn(1,5528) end) from dual) is null-- xppw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3474=cast((chr(113)||chr(106)||chr(107)||chr(118)||chr(113))||(select (case when (3474=3474) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(98)||chr(113)||chr(113)) as numeric)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 3959 in (select (char(113)+char(106)+char(107)+char(118)+char(113)+(select (case when (3959=3959) then char(49) else char(48) end))+char(113)+char(106)+char(98)+char(113)+char(113)))-- xkva] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 or (select 1924 from(select count(*),concat(0x716a6b7671,(select (elt(1924=1924,1))),0x716a627171,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 1480=convert(int,(select char(113)+char(106)+char(107)+char(118)+char(113)+(select (case when (1480=1480) then char(49) else char(48) end))+char(113)+char(106)+char(98)+char(113)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Soria S, Gallego E, Vidan M, Ortiz J, Serra-Rexach JA. [Development of a risk-mortality index for elderly patients discharged from a geriatric acute care unit]. Rev Esp Geriatr Gerontol 2013; 49:223-7. [PMID: 24060412 DOI: 10.1016/j.regg.2013.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index. METHODS AND ANALYSIS Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations. CONCLUSIONS The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives.
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Affiliation(s)
- Selene Soria
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Eva Gallego
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Maite Vidan
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Javier Ortiz
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Strand JJ, Kamdar MM, Carey EC. Top 10 things palliative care clinicians wished everyone knew about palliative care. Mayo Clin Proc 2013; 88:859-65. [PMID: 23910412 DOI: 10.1016/j.mayocp.2013.05.020] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 12/25/2022]
Abstract
With a focus on improving quality of life for patients, palliative care is a rapidly growing medical subspecialty focusing on the care of patients with serious illness. Basic symptom management, discussions of prognostic understanding, and eliciting treatment goals are essential pieces in the practice of nearly all physicians. Nonetheless, many complex patients with a serious, life-threatening illness benefit from consultation with palliative care specialists, who are trained and experienced in complex symptom management and challenging communication interactions, including medical decision making and aligning goals of care. This article discusses the changing role of modern palliative care, addresses common misconceptions, and presents an argument for early integration of palliative care in the treatment of patients dealing with serious illness.
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Affiliation(s)
- Jacob J Strand
- Department of Internal Medicine, Palliative Care Section, Mayo Clinic, Rochester, MN.
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125
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Zambroski CH, Bekelman DB. Palliative symptom management in patients with heart failure. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992608x346206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Steel A, Bakhai A. Proposal for routine use of mortality risk prediction tools to promote early end of life planning in heart failure patients and facilitate integrated care. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.09.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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128
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Lowey SE, Norton SA, Quinn JR, Quill TE. Living with advanced heart failure or COPD: experiences and goals of individuals nearing the end of life. Res Nurs Health 2013; 36:349-58. [PMID: 23754626 DOI: 10.1002/nur.21546] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/09/2022]
Abstract
The last phase of life of patients with end-stage heart failure (HF) or chronic obstructive pulmonary disease (COPD) is marked by high symptom burden and uncertainty about the future. Few enroll in hospice, and their preferences for care remain unknown. The purpose of this qualitative study was to describe the experiences and goals for care of patients with end-stage HF and COPD who were recently discharged from the hospital. Forty semi-structured interviews were completed with 20 participants. Despite conditions considered life-threatening by clinicians, participants believed they still had time. They hoped that their illnesses would remain stable, although specific experiences made them think they might be worsening. All expected that their doctors would tell them when their illnesses became life-threatening.
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Affiliation(s)
- Susan E Lowey
- University of Rochester School of Nursing, 601 Elmwood Ave., Rochester, NY 14642, USA
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129
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:e240-327. [PMID: 23741058 DOI: 10.1161/cir.0b013e31829e8776] [Citation(s) in RCA: 1522] [Impact Index Per Article: 138.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
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- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62:e147-239. [PMID: 23747642 DOI: 10.1016/j.jacc.2013.05.019] [Citation(s) in RCA: 4538] [Impact Index Per Article: 412.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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131
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Morrison RS. Research priorities in geriatric palliative care: an introduction to a new series. J Palliat Med 2013; 16:726-9. [PMID: 23721426 DOI: 10.1089/jpm.2013.9499] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Sean Morrison
- National Palliative Care Research Center, Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA.
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Kheirbek RE, Alemi F, Citron BA, Afaq MA, Wu H, Fletcher RD. Trajectory of Illness for Patients with Congestive Heart Failure. J Palliat Med 2013; 16:478-84. [DOI: 10.1089/jpm.2012.0510] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Raya E. Kheirbek
- Office of Chief of Staff, Washington DC Veterans Affairs Medical Center, Washington, DC
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Farrokh Alemi
- Office of Chief of Staff, Washington DC Veterans Affairs Medical Center, Washington, DC
- Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, Florida
| | - Bruce A. Citron
- Research Service, Bay Pines VA Healthcare System, Bay Pines, Florida
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Mazhar A. Afaq
- Department of Cardiology, Bay Pines VA Healthcare System, Bay Pines, Florida
| | - Halcyon Wu
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Ross D. Fletcher
- Office of Chief of Staff, Washington DC Veterans Affairs Medical Center, Washington, DC
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
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Lingard LA, McDougall A, Schulz V, Shadd J, Marshall D, Strachan PH, Tait GR, Arnold JM, Kimel G. Understanding palliative care on the heart failure care team: an innovative research methodology. J Pain Symptom Manage 2013; 45:901-11. [PMID: 23017607 PMCID: PMC5650481 DOI: 10.1016/j.jpainsymman.2012.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/17/2012] [Accepted: 05/08/2012] [Indexed: 01/03/2023]
Abstract
CONTEXT There is a growing call to integrate palliative care for patients with advanced heart failure (HF). However, the knowledge to inform integration efforts comes largely from interview and survey research with individual patients and providers. This work has been critically important in raising awareness of the need for integration, but it is insufficient to inform solutions that must be enacted not by isolated individuals but by complex care teams. Research methods are urgently required to support systematic exploration of the experiences of patients with HF, family caregivers, and health care providers as they interact as a care team. OBJECTIVES To design a research methodology that can support systematic exploration of the experiences of patients with HF, caregivers, and health care providers as they interact as a care team. METHODS This article describes in detail a methodology that we have piloted and are currently using in a multisite study of HF care teams. RESULTS We describe three aspects of the methodology: the theoretical framework, an innovative sampling strategy, and an iterative system of data collection and analysis that incorporates four data sources and four analytical steps. CONCLUSION We anticipate that this innovative methodology will support groundbreaking research in both HF care and other team settings in which palliative integration efforts are emerging for patients with advanced nonmalignant disease.
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Affiliation(s)
- Lorelei A Lingard
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
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Abstract
Older people reaching end-of-life status are particularly at risk of adverse effects of drug therapy. Polypharmacy, declining organ function, co-morbidity, malnutrition, cachexia and changes in body composition all sum up to increase the risk of many drug-related problems in individuals who receive end-of-life care. End of life is defined by a limited lifespan or advanced disability. Optimal prescribing for end-of-life patients with multimorbidity, especially in those dying from non-cancer conditions, remains mostly unexplored, despite the increasing recognition that the management goals for patients with chronic diseases should be redefined in the setting of reduced life expectancy. Most drugs used for symptom palliation in end-of-life care of older patients are used without solid evidence of their benefits and risks in this particularly frail population. Appropriate dosing or optimal administration routes are in most cases unknown. Avoiding or discontinuing drugs that aim to prolong life or prevent disability is usually common sense in end-of-life care, particularly when the time needed to obtain the expected benefits from the drug is longer than the life expectancy of a particular individual. However, discontinuation of drugs is not standard practice, and prescriptions are usually not adapted to changes in the course of advanced diseases. Careful consideration of remaining life expectancy, time until benefit, goals of care and treatment targets for each drug seems to be a sensible framework for decision making. In this article, some key issues on drug therapy at the end of life are discussed, including principles of decision making about drug treatments, specific aspects of drug therapy in some common geriatric conditions (heart failure and dementia), treatment of acute concurrent problems such as infections, evidence to guide the choice and use of drugs to treat symptoms in palliative care, and avoidance of some long-term therapies in end-of-life care. Solid evidence is lacking to guide optimal pharmacotherapy in most end-of-life settings, especially in non-cancer diseases and very old patients. Some open questions for research are suggested.
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135
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Kehl KA, Kowalkowski JA. A systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life. Am J Hosp Palliat Care 2012; 30:601-16. [PMID: 23236090 DOI: 10.1177/1049909112468222] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To optimally manage patient care, knowledge of the prevalence of signs of impending death and common symptoms in the last days is needed. Two reviewers independently conducted searches of PubMed, CINAHL, PsychINFO and the Web of Knowledge from January, 1996 to May, 2012. No limits to publication language or patient diagnosis were imposed. Peer reviewed studies of adults that included contemporaneous documentation of signs and symptoms were included. Articles were excluded if they assessed symptoms by proxy or did not provide information on prevalence. Reviewers independently extracted data. Twelve articles, representing 2416 patients, in multiple settings were analyzed. Of the 43 unique symptoms, those with the highest prevalence were: dyspnea (56.7%), pain (52.4%), respiratory secretions/death rattle (51.4%), and confusion (50.1%). Overall prevalence may be useful in anticipating symptoms in the final days and in preparing families for signs of impending death.
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Affiliation(s)
- Karen A Kehl
- School of Nursing, University of Wisconsin-Madison, WI 53792, USA.
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Dev S, Abernethy AP, Rogers JG, O'Connor CM. Preferences of people with advanced heart failure-a structured narrative literature review to inform decision making in the palliative care setting. Am Heart J 2012; 164:313-319.e5. [PMID: 22980296 DOI: 10.1016/j.ahj.2012.05.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 05/22/2012] [Indexed: 12/20/2022]
Abstract
UNLABELLED BACKGROUND AND APPROACH: There is a growing emphasis on the need for high-quality and patient-centered palliative care for patients with heart failure (HF) near end of life. Accordingly, clinicians require adequate knowledge of patient values and preferences, but this topic has been underreported in the HF literature. In response, we conducted a structured narrative review of available evidence regarding patient preferences for HF care near end of life, focusing on circumstances of death, advance care planning, and preferences for specific HF therapies. RESULTS Patients had widely varying preferences for sudden ("unaware") death versus a death that was anticipated ("aware"), which would allow time to make arrangements and time with family; preferences influenced their choice of HF therapies. Patients and physicians rarely discussed advance care planning; physicians were rarely aware of resuscitation preferences. Advance care planning discussions rarely included preferences for limiting implantable cardioverter defibrillator use, and patients were often uninformed of the option of implantable cardioverter defibrillator deactivation. A substantial minority of patients strongly preferred improved quality of life versus extended survival, but preferences of individuals could not be easily predicted. CONCLUSIONS Current evidence regarding preferences of patients with HF near end of life suggests substantial opportunities for improvement of end-of-life HF care. Most notably, the wide distribution of patient preferences highlights the need to tailor approach to patient wishes, avoiding assumptions of patient wishes. A research agenda and implications for health care provider training are proposed.
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Affiliation(s)
- Sandesh Dev
- Phoenix Veterans Administration Health Care System, AZ, USA.
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138
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Burton AM, Sautter JM, Tulsky JA, Lindquist JH, Hays JC, Olsen MK, Zimmerman SI, Steinhauser KE. Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers. J Pain Symptom Manage 2012; 44:410-20. [PMID: 22727950 PMCID: PMC3432705 DOI: 10.1016/j.jpainsymman.2011.09.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 09/16/2011] [Accepted: 09/22/2011] [Indexed: 11/22/2022]
Abstract
CONTEXT Three important causes of death in the U.S. (cancer, congestive heart failure, and chronic obstructive pulmonary disease) are preceded by long periods of declining health; often, family members provide most care for individuals who are living with serious illnesses and are at risk for impaired well-being. OBJECTIVES To expand understanding of caregiver burden and psychosocial-spiritual outcomes among understudied groups of caregivers-cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers-by including differences by disease in a diverse population. METHODS The present study included 139 caregiver/patient dyads. Independent variables included patient diagnosis and function; and caregiver demographics, and social and coping resources. Cross-sectional analyses examined distributions of these independent variables between diagnoses, and logistic regression examined correlates of caregiver burden, anxiety, depressive symptoms, and spiritual well-being. RESULTS There were significant differences in patient functioning and caregiver demographics and socioeconomic status between diagnosis groups but few differences in caregiver burden or psychosocial-spiritual outcomes by diagnosis. The most robust social resources indicator of caregiver burden was desire for more help from friends and family. Anxious preoccupation coping style was robustly associated with caregiver psychosocial-spiritual outcomes. CONCLUSION Caregiver resources, not patient diagnosis or illness severity, are the primary correlates associated with caregiver burden. Additionally, caregiver burden is not disease specific to those examined here, but it is rather a relatively universal experience that may be buffered by social resources and successful coping styles.
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Affiliation(s)
- Allison M Burton
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1439, USA.
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139
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Grinnan DC, Swetz KM, Pinson J, Fairman P, Lyckholm LJ, Smith T. The end-of-life experience for a cohort of patients with pulmonary arterial hypertension. J Palliat Med 2012; 15:1065-70. [PMID: 22845004 DOI: 10.1089/jpm.2012.0085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a progressive and ultimately fatal disease of the pulmonary circulation. There has never been an investigation of the end-of-life symptoms in patients with PAH. In this investigation, we surveyed surrogates of recent decedents with PAH. We evaluate their responses to better understand the end-of-life experience of patients with PAH. METHODS The survey instrument includes demographic information and the Edmonton Symptoms Assessment Scale. Accredo Therapeutics mailed the survey to surrogates of recent decedents with PAH, and responses were anonymously returned to investigators at Virginia Commonwealth University and used in our descriptive analysis. RESULTS Of 100 surveys distributed over 24 months (February 2009 to February 2011), we obtained 36 responses (response rate 36%). We found that most patient deaths (90%) were related to PAH, that the majority of patients died in the hospital (67%), with the majority of in-hospital deaths (83%) occurring in intensive care. Palliative care was infrequently involved in patients' care, and many surrogates were unaware of palliative care and hospice services available to the decedents. Patients died with a high symptom burden, especially dyspnea. CONCLUSION In this cohort, patients with PAH usually died from their disease, often in the hospital setting with a high symptom burden. Further study will be needed to confirm the findings from this study and to better understand the forces leading to the trends uncovered in this investigation.
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Affiliation(s)
- Daniel C Grinnan
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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140
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Janssen DJA, Spruit MA, Wouters EFM, Schols JMGA. Symptom distress in advanced chronic organ failure: disagreement among patients and family caregivers. J Palliat Med 2012; 15:447-56. [PMID: 22475192 DOI: 10.1089/jpm.2011.0394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Proxy reporting is frequently used to assess symptom distress of patients with advanced chronic organ failure. The aim of the present cross-sectional study was to examine agreement in severity of symptom distress, presence of symptom-related interventions, and satisfaction with medical treatment among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) and their family caregivers. METHODS Outpatients with advanced COPD (n=73), CHF (n=45) and CRF (n=41) and their family caregivers rated severity of physical and psychological symptoms experienced by the patient using Visual Analogue Scales (VAS). The presence of symptom-related interventions was recorded by patients and family caregivers. Finally, patients and family caregivers rated satisfaction with medical treatment of the patient using VAS. Agreement was determined using intraclass correlation coefficients (ICC) for continuous variables and Cohen's kappa for categorical variables. RESULTS Family caregivers reported a higher number of symptoms than patients (mean [standard deviation; SD]: 8.2 [3.5] versus 7.3 [3.6], respectively [p<0.0005]). For most symptoms, agreement about severity between patients and family caregivers was moderate (ICC: 0.41-0.60). Agreement about satisfaction with medical treatment was fair (ICC [95% confidence interval; CI]: 0.21 [0.05-0.35]). Agreement was poor to moderate for presence of symptom-related interventions (kappa: -0.03-0.54). CONCLUSIONS Studies using proxy reporting reflect the views of proxies and do not accurately represent the patients' experience. For clinical care, it's important to pay attention to the perception from the patient as well as the perception from the family caregiver of symptom distress, presence of symptom-related interventions, and satisfaction with treatment.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
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141
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Hopp FP, Thornton N, Martin L, Zalenski R. Life disruption, life continuation: contrasting themes in the lives of African-American elders with advanced heart failure. SOCIAL WORK IN HEALTH CARE 2012; 51:149-172. [PMID: 22352363 DOI: 10.1080/00981389.2011.599016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness.
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Affiliation(s)
- Faith Pratt Hopp
- School of Social Work, Wayne State University, Detroit, MI, USA.
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142
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143
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144
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End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis. Br J Gen Pract 2011; 61:e49-62. [PMID: 21401993 DOI: 10.3399/bjgp11x549018] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Current models of end-of-life care (EOLC) have been largely developed for cancer and may not meet the needs of heart failure patients. AIM To review the literature concerning conversations about EOLC between patients with heart failure and healthcare professionals, with respect to the prevalence of conversations; patients' and practitioners' preferences for their timing and content; and the facilitators and blockers to conversations. DESIGN OF STUDY Systematic literature review and narrative synthesis. METHOD Searches of Medline, PsycINFO and CINAHL databases from January 1987 to April 2010 were conducted, with citation and journal hand searches. Studies of adult patients with heart failure and/or their health professionals concerning discussions of EOLC were included: discussion and opinion pieces were excluded. Extracted data were analysed using NVivo, with a narrative synthesis of emergent themes. RESULTS Conversations focus largely on disease management; EOLC is rarely discussed. Some patients would welcome such conversations, but many do not realise the seriousness of their condition or do not wish to discuss end-of-life issues. Clinicians are unsure how to discuss the uncertain prognosis and risk of sudden death; fearing causing premature alarm and destroying hope, they wait for cues from patients before raising EOLC issues. Consequently, the conversations rarely take place. CONCLUSION Prognostic uncertainty and high risk of sudden death lead to EOLC conversations being commonly avoided. The implications for policy and practice are discussed: such conversations can be supportive if expressed as 'hoping for the best but preparing for the worst'.
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145
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Solano JPC, Scazufca M, Menezes PR. Frequência de sintomas no último ano de vida de idosos de baixa renda em São Paulo: estudo transversal com cuidadores informais. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2011. [DOI: 10.1590/s1415-790x2011000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O crescimento da população idosa brasileira fez aumentar a prevalência de doenças crônicas e o número de pessoas sofrendo de diversos sintomas ao final da vida. Este estudo objetivou entrevistar cuidadores de idosos falecidos, investigando a presença, intensidade e duração de sintomas no último ano, e se os mesmos foram tratados. Arrolaram-se idosos por inquérito domiciliar de base populacional em setores de baixa renda do Butantã, São Paulo. Eram elegíveis os idosos falecidos durante o período de dois anos de seguimento. Oitenta e um cuidadores foram entrevistados entre três e 16 meses pós-óbito e responderam um questionário sobre onze sintomas. Os sintomas mais referidos foram dor (78%), fadiga (68%), dispnéia (60%), depressão e anorexia (58% cada). Dor, dispnéia e fadiga foram os mais intensos. Dor, fadiga e depressão duraram 6 meses ou mais. Ficaram sem tratamento 79% dos idosos com depressão, 77% daqueles com incontinência urinária e 67% daqueles com ansiedade. É necessário implementar conceitos e ações de cuidados paliativos para dar aos idosos mais dignidade e qualidade ao final da vida.
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146
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Burns CM, LeBlanc TW, Abernethy A, Currow D. Young caregivers in the end-of-life setting: a population-based profile of an emerging group. J Palliat Med 2011; 13:1225-35. [PMID: 20858060 DOI: 10.1089/jpm.2010.0004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Little is known about young caregivers of people with advanced life-limiting illness. Better understanding of the needs and characteristics of these young caregivers can inform development of palliative care and other support services. METHODS A population-based analysis of caregivers was performed from piloted questions included in the 2001-2007 face-to-face annual health surveys of 23,706 South Australians on the death of a loved one, caregiving provided, and characteristics of the deceased individual and caregiver. The survey was representative of the population by age, gender, and region of residence. FINDINGS Most active care was provided by older, close family members, but large numbers of young people (ages 15-29) also provided assistance to individuals with advanced life-limiting illness. They comprised 14.4% of those undertaking "hands-on" care on a daily or intermittent basis, whom we grouped together as active caregivers. Almost as many young males as females participate in active caregiving (men represent 46%); most provide care while being employed, including 38% who work full-time. Over half of those engaged in hands-on care indicated the experience to be worse or much worse than expected, with young people more frequently reporting dissatisfaction thereof. Young caregivers also exhibited an increased perception of the need for assistance with grief. CONCLUSION Young people can be integral to end-of-life care, and represent a significant cohort of active caregivers with unique needs and experiences. They may have a more negative experience as caregivers, and increased needs for grief counseling services compared to other age cohorts of caregivers.
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Affiliation(s)
- Catherine Mary Burns
- Palliative & Supportive Service, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
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147
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Gheorghe C, Vazquez R, Casanegra AI, Argento V, Dadu R, Feng Y, Amoateng-Adjepong Y, Manthous CA. Elders' environs and their end-of-life preferences. J Am Med Dir Assoc 2011; 12:22-8. [PMID: 21194655 DOI: 10.1016/j.jamda.2009.12.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 12/28/2009] [Accepted: 12/28/2009] [Indexed: 11/29/2022]
Abstract
HYPOTHESIS Elders' predilections regarding end-of-life interventions vary with their living environs. METHODS Patients in 3 settings--assisted living/outpatient, skilled nursing facility (SNF), and acute hospitalization--were asked to complete a brief questionnaire. RESULTS A total of 269 patients who averaged 80.0 ± (SD) 8.1 years, 44% male, 70% white were studied. Eighty-five patients were outpatient elderly, 101 were hospitalized for acute illnesses, and 83 were interviewed in SNFs. Outpatients (44/85; 52%) and acutely ill inpatients (40/101; 40%) were more likely than patients residing in SNFs (19/81; 23%) to choose comfort care only (P = .047) for acute pneumonia requiring endotracheal intubation (ETI). Overall, 32% changed their choice for ETI, opting for comfort care only if acute pneumonia was followed by disposition to an SNF. However, ambulatory and acutely ill elderly patients were 3 times as likely as SNF patients to change from aggressive to comfort care if the most likely outcome was disposition to an SNF (P < .001). In multivariate regression models, age (>80), gender, number of lost ADLs (>2), and self-described quality of life were not associated with choosing comfort care instead of ETI, whereas place of residence (SNF versus home) was independently associated with choosing ETI (odds ratio = 3.5; 95%CI = 1.9-6.4). Similarly, those already living in an SNF were more likely to opt for remaining there for advancing dementia (odds ratio = 7.7; 95%CI = 3.8-15.8). However, choices for ETI did not coincide with choosing an SNF for advancing dementia. CONCLUSIONS Elders residing in nursing homes were more likely than ambulatory patients to request invasive end-of-life care, a difference that was more pronounced when outcome required disposition to an SNF. These preferences were not dependent on patients' self-described disability or quality of life. This study suggests that qualitative outcomes matter to patients and their choices are associated with their place of residence.
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Affiliation(s)
- Cristina Gheorghe
- Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA
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148
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Heart Failure and Palliative Care. Palliat Care 2011. [DOI: 10.1016/b978-1-4377-1619-1.00027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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149
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Klijs B, Mackenbach JP, Kunst AE. Disability occurrence and proximity to death. Disabil Rehabil 2010; 32:1733-41. [PMID: 20373858 DOI: 10.3109/09638281003746049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE This paper aims to assess whether disability occurrence is related more strongly to proximity to death than to age. METHOD Self reported disability and vital status were available from six annual waves and a subsequent 12-year mortality follow-up of the Dutch GLOBE longitudinal study. Logit and Poisson regression methods were used to study associations of disability occurrence with age and with proximity to death. RESULTS For disability in activities of daily living (ADL), regression models with proximity to death had better goodness of fit than models with age. With approaching death, the odds for ADL disability prevalence and incidence rates increased 20.0% and 18.9% per year, whereas severity increased 4.1% per year. For the ages younger than 60, 60-69 and older than 70 years, the odds for ADL disability prevalence increased 6.4%, 16.0% and 23.0% per year. Among subjects with asthma/chronic obstructive pulmonary disease, heart disease and diabetes increases were 25.1%, 19.5% and 22.7% per year. Functional impairments were more strongly related to age. CONCLUSIONS The strong association of (ADL) disability occurrence with proximity to death implies that a substantial part of the disability burden may shift to older ages with further increases in life expectancy.
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Affiliation(s)
- Bart Klijs
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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150
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Janssen DJA, Spruit MA, Schols JMGA, Wouters EFM. A call for high-quality advance care planning in outpatients with severe COPD or chronic heart failure. Chest 2010; 139:1081-1088. [PMID: 20829337 DOI: 10.1378/chest.10-1753] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with severe COPD or chronic heart failure (CHF) are often confronted with decisions concerning life-sustaining treatments. The aim of this prospective, observational study was to assess life-sustaining treatment preferences, advance care planning, and the quality of end-of-life care communication in Dutch outpatients with clinically stable but severe COPD or CHF. METHODS The following outcomes were assessed in outpatients with severe COPD (n = 105) or CHF (n = 80): life-sustaining treatment preferences (CPR and mechanical ventilation; Willingness to Accept Life-sustaining Treatment instrument), advance care planning, and quality of end-of-life care communication (Quality of Communication questionnaire). RESULTS Most patients asserted that in their current health status, they would prefer CPR (COPD, 70.5%; CHF, 62.5%) and/or mechanical ventilation (COPD, 70.5%; CHF, 66.3%). Patients' treatment preferences were influenced by burden of treatment, outcome of treatment, and likelihood of outcome. Advance directives were discussed with the physician specialist by 5.9% of patients with COPD and 3.9% of patients with CHF. Patients rated quality of patient-physician end-of-life care communication as poor. Physicians rarely discussed prognosis, dying, and palliative care. CONCLUSIONS Despite the fact that patients are able to indicate their preferences regarding life-sustaining treatments, based on burden of treatment, outcome of treatment, and likelihood of outcome, these preferences are rarely discussed with their physician specialist. This study shows a need for advance care planning, taking into account the burden of treatment, outcome of treatment, and likelihood of outcome, in patients with severe COPD or CHF. Finally, the quality of patient-physician end-of-life care communication needs to improve.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Proteion Thuis, Horn, The Netherlands; CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - Martijn A Spruit
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Jos M G A Schols
- Department of General Practice, Nursing Home Medicine, Faculty of Health Medicine and Life sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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