Approximately 900,000 people in the UK have heart failure (HF) with 30–40% dying within a year. The incidence of HF is increasing. Patients have a high symptom burden; patients with HF will have similar numbers of symptoms to cancer patients. As UK life expectancy increases palliative services will need to provide more support to this patient group.
This retrospective audit assessed care from Severn Hospice to HF patients admitted to the hospice since November 2015. NICE guideline 'Chronic Heart Failure in Adults: Management' was used as the gold standard.
Of 962 patients admitted to the hospice, 13 had a diagnosis of HF. 9 had a primary diagnosis and 4 had HF as a co-morbidity. The majority of patients were referred for symptom control. At admission patients had a mean of 4.38 (range 1–7) symptoms. 9 patients had symptoms not in the NICE guideline including constipation, diarrhoea, anxiety, agitation and hallucinations. The majority had more symptoms at admission than at initial referral (mean 4.84). 9 patients had syringe drivers during their admission; 3 were furosemide infusions.
All patients had some advance care planning (ACP). All had a 'do not resuscitate order'. Preferred place of death was documented in 12 patients (1 had no capacity). 9 had a preferred place of care. No patients had an advance directive to refuse treatment. Most ACP was done on admission.
Surprisingly few patients with HF are admitted to the hospice. These patients have a significant symptom burden including some symptoms not always associated with HF. This suggests that the needs of HF patients are not being met. As a result efforts are being made to set up a joint HF and palliative care MDT. With this and increasing numbers of patients the hospice will continue to gain expertise in managing these patients.
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