Supportive Care in Heart Failure
Supportive Care Series

Heart failure occurs in almost epidemic proportions, placing a huge burden on both the healthcare system, and sufferers and their families. This can only rise over coming years as the ageing population, particularly in industrialized countries, increasingly suffers from heart failure and its related comorbidities. The care of this group of patients has evolved significantly over recent years as our knowledge and understanding of the pathophysiology of heart failure has developed. It has become evident that supportive care is integral to comprehensive heart failure care, and this book provides an evidence-based overview of heart failure aetiology, its management, and the supportive care required by patients throughout the course of their disease. Supportive Care in Heart Failure integrates the complexities of heart failure care, bridging knowledge bases from cardiology and cardiothoracic surgery, general medicine and palliative care. The book reviews essential information about epidemiology and pathophysiology of heart failure, and evidence-based medical, device, surgical and interdisciplinary management. It addresses the evaluation and management of quality of life, common symptoms and problems associated with heart failure, and the holistic approach to supportive care throughout the course of the illness through the end of life. Prognostication, communication, and ethical decision making are reviewed in detail. Heart failure has traditionally presented a challenge to physicians, as a generally progressive condition with significant symptoms, a poor quality of life, and high mortality. But by applying the principles of palliative medicine, it is possible to offer a supportive care approach that synthesizes the experience of both the heart failure specialist and the palliative care physician, and offers the best possible quality of care to this group of patients.

Part 1 : Heart failure. Introduction - an overview of supportive care in heart failure. The epidemiology of heart failure. The pathophysiology of heart failure. Heart failure optimal pharmacological therapy. Device therapy for heart failure patients. Advanced heart failure, the role of the surgeon. Interdisciplinary care. Part 2 : Patient-symptomatic burden. Quality of life in heart failure. Dyspnoea. Sleep disordered breathing in congestive heart failure. Fatigue and exercise intolerance. Pain in heart failure patients. Cardiac cachexia. Cognitive impairment. Depression and anxiety in patients with chronic heart failure. Spiritual issues in heart failure. Heart failure in the elderly/co-morbidities. The course to death in heart failure. The last few days of life. Bereavement support for patients and families. Part 3 : Prognostication and communication. Mortality risk assessment and prognostication. Communication between clinicians and their heart failure patients and families. Decision-making in advanced heart failure. Ethical dilemmas in therapy withdrawal. Challenges of cultural diversity. Palliative care research in the face of uncertainty. Coping with patients' deaths.

James Beattie has had a long interest in heart failure. He was Clinical Lecturer in Cardiovascular Medicine at the University of Birmingham and was appointed Consultant Cardiologist at Heartlands Hospital in 1990. For about 15 years he has had an interest in palliative care for heart failure and for the past 3 years has been a National Clinical Lead for the NHS Heart Improvement Programme promoting the development of such services across England. He is a member of the Circulatory Forum of the National Council for Palliative Care and the Department of Health End of Life Care Strategy Group. He is also a member of the British Cardiovascular Society and holds fellowships of the European Society of Cardiology and the Royal Colleges of Physicians of Glasgow and London. Sarah Goodlin is a geriatrician and palliative care physician in Salt Lake City. Dr Goodlin developed the New Hampshire End of Life Project, a two-year project that initiated a state-wide collaborative to improve end of life care and developed outcome measures for care of persons near the end of life. In 1998 she initiated quality improvement projects for care of the frail elderly and for persons with advanced heart failure. In 2002 and 2003 Dr Goodlin directed two consensus conferences on Palliative and Supportive Care in Advanced Heart Failure, funded by the Agency for Healthcare Quality and the Robert Wood Johnson Foundation. She directs the Palliative Care-Heart Failure Education and Research Collaborative, a national working group of researchers and clinicians formed to improve quality of life and meet the needs of patients with advanced heart failure and their families. Dr Goodlin was also a member of the Board of Directors of the American Academy of Hospice and Palliative Medicine.