Palliative Care Options for

People with Heart Disease

Palliative care can relieve painful symptoms of heart
disease
Heart Disease: #1 Cause of Death in Adults

Heart disease is the leading cause of death in adults. Heart disease is more than just clogged
arteries and heart attacks. It has many faces with more ways than one to cause death. Some
of the more common forms of heart disease include:

Coronary artery disease

Heart failure
Heart rhythm disorders and
Heart valve disease

Although its often thought of as a mans problem, heart disease is the No.1 killer of women
as well.
Thats right, ladies. Its not just breast cancer you need to worry about. Unfortunately, the
signs of heart disease and heart attack in women can be different than those in men and are
too often missed, making it even more deadly.

Why Few Heart Patients Choose Palliative Care

Even though heart disease prevails over cancer as the top killer, it still falls behind cancer as
a reason for admission to hospice. A likely reason for this is that patients aren't always sure
when palliative care is appropriate for their illness and, often times, neither are their
doctors. Cancer is a disease that most patients fight full force until its obvious that the
treatment is no longer working. Treatment for heart disease is more complicated.

Most patients with heart disease end up in a type of revolving door when it comes to
treatment. Their symptoms get severe, they are hospitalized until their symptoms are stable,
then discharged home until the symptoms worsen once again.

They will continue in this cycle as their outcome becomes bleaker and are often not aware
that there is another alternative.
When Is Palliative Care Appropriate?

Palliative care is a valid choice for many patients with severe heart disease who are
experiencing distressing symptoms that are difficult to control.

Symptoms of heart disease that may lead a patient to seek palliative care or hospice may
include:

Chest pain, or angina at rest

Shortness of breath, or dyspnea at rest
Persistent symptoms, such as edema or swelling, in the feet despite aggressive
treatment
Inability to tolerate aggressive treatments because of low blood pressure or kidney
disease
History of heart attacks and/or resuscitation
It's important to note, however, that many patients with distressing symptoms aren't
necessarily getting the best possible medical care for their heart failure. Before
considering palliative care, the patient should seek the advice of at least one and
preferably two board-certified cardiologists. If these specialists deem that everything
is being done to manage the heart failure and nothing is left to offer that will control
their symptoms better or prolong their life, then palliative care may be an excellent
choice.
Heart disease patients who choose comfort care have typically been through multiple
hospitalizations and have decided that they want to avoid further ones.
The palliative care team works with the patient and their caregivers to manage
disabling symptoms. Its a common myth that palliative and hospice care means
giving up treatment. Patients typically stay on all of their heart medications as long
as they can tolerate them, and new medications may even be started.
Top Palliative Options for Heart Patients
One of the more common medications that may be added once a patient is on
palliative care or hospice for heart disease is morphine. This isnt because the patient
is terminal, which is a common misconception. Morphine is effective at treating
shortness of breath, or dyspnea, which is a common symptom in advanced heart
disease. It relaxes the chest wall muscles, dilates the blood vessels in the lungs and
reduces the sensation of breathlessness in the brain. Other opiate pain
medications, such as Methadone, may be substituted and work equally as well.
In addition to managing medications to optimize comfort, the palliative care team
may recommend oxygen therapy if the patient isnt already using it. They may also
recommend having a hospital bed in the home to facilitate easier breathing while in
bed. Raising the head of the bed reduces pressure on the lungs, making breathing
more comfortable. Hospice agencies will always order any prescribed medications for
comfort and any equipment needed, which are delivered directly to the patient.
If youre considering palliative care for your heart disease or for someone you love,
talk with your physician about the advantages and the potential disadvantages of
hospice care as it relates to you personally.
What Is the Palliative Care
Treatment?
By Angela Morrow, RN
Updated March 03, 2017

Palliative care is a vague and often confusing term to describe a type of treatment
model. People of ask: Is it end-of-life care? Is it the same as hospice? What is
palliative care?

Palliative care is treatment aimed at relieving the symptoms associated with

serious illnesses and improving a patient's quality of life. Contrary to popular
belief, it is NOT hospice care. Unlike hospice care, palliative care can begin at any
time during a serious illness and ideally at the time of diagnosis.

Palliative Care for Cancer

Palliative care is most often utilized by cancer patients in the form of treatments such
as palliative chemotherapy and palliative radiation. Chemotherapy and radiation
treatments that are considered "palliative" are those that will not cure cancer, but offer relief
of symptoms. An example of this is a woman with a brain tumor causing severe headaches
and blurred vision who undergoes radiation to shrink the tumor and relieve her symptoms.

Cancer patients who are undergoing curative cancer therapy are also prime candidates for
palliative care. Aggressive palliative care can relieve distressing side effects from cancer
treatmentnausea and vomiting, fatigue, pain, and thrush are just a few of the symptoms
palliative care can address.

Palliative Care Is Not Only For Cancer

Other serious illnesses can also benefit from palliative care. Heart failure patients can get
relief from chest pain, fluid retention (edema), and shortness of breath.

Liver failure patients can receive intensive treatments for abdominal pain and
swelling, itching, and nausea. Patients with respiratory disease can manage shortness of
breath and improve the quality of life. Any serious illness that negatively impacts a patient's
quality of life can benefit from palliative care.
And perhaps the biggest benefit of palliative care? Patients who receive palliative care
live longer than patients who receive standard care. If patients can live a longer life with
improved quality of life, why isn't palliative care more popular? It's partly due to the
misconception that palliative care is the same as hospice care.

Palliative Care Does Not Equal Hospice Care

Hospice care is simply one form of palliative care that is appropriate for patients in the final
stage of lifethose with a life expectancy of six months or less. Like palliative care, hospice
care is designed to relieve symptoms and improve the quality of life, but hospice is restricted
to patients who are terminally ill.

Palliative care can be given regardless of life expectancy. Palliative care can begin as early in
a patient's illness as is necessary to control symptoms and improve the quality of life.

Palliative Care Goals

The goal of palliative care is simply to relieve suffering and improve the quality of life.
Further goals are then based on the patient's wishes in consultation with the palliative care
team.

Palliative care is more than just treating physical symptoms, however. Palliative care also
addresses emotional suffering and spiritual care needs.

The Palliative Care Team

Palliative care is often carried out by a team of professionals who can address multiple
concerns. The team may include:

Palliative care physicians

Palliative care nurse practitioners
Nurses
Social workers
Chaplains
Therapists (occupational, speech, physical, etc.)

The most important member of the palliative care team is you. Palliative care should be
directed toward meeting your personal goals. It is your responsibility as a palliative care
patient to make your goals and health care wishes known.
Sources:

Jennifer S. Temel, M.D., et al. "Early Palliative Care for Patients with Metastatic NonSmall-
Cell Lung Cancer" New England Journal of Medicine. N Engl J Med 2010; 363:733-742.

Phillip D. Good, John Cavenagh, Peter J. Ravenscroft. "Survival after enrollment in an

Australian palliative care program". Journal of Pain and Symptom Management 2004;27:4 Pages
310-315.

FINAL CONSIDERATIONS

The Palliative Care Model emerged to attend to the needs of patients without therapeutic
possibilities. Therefore, its adoption in cancer patient care is extremely important and
continues being a growing need at health institutions and in the home context.

As observed, the dimension of the suffering associated with cancer has been demonstrating
the urgent need to develop a scientific and humanistic care that permits health teams and
institutions to give an efficient answer to the problem experienced by patients and family
members.

In accordance with these reflections, care in the Humanistic Nursing Theory and in the
Palliative Care Model allows for self-realization, which is how human beings live the true
meaning of their existence.

However, the humanistic nursing theoreticians defend does not reject technological
advances in health. On the opposite, it expands their value by considering their use in the
perspective of human development. In the same way, Palliative Care values high levels of
contact as a central point for human dignity, however, without overestimating it in patient
care.

The care actions inserted in the humanistic perspective and in palliative therapeutic
measures go beyond the performance of certain technical procedures. They involve being-
with and being-there, which imply the nurse's active presence. Being-with requires attention
for the being who receives care, remaining on the alert for an opening in the shared
situation, as well as communicating this availability, as it is an existential commitment
aimed at adding to and developing human potential.