Tag Archives: palliative care

NICE heart failure guidelines The latest National Institute for Health and Care Excellence (NICE) guidelines for management of chronic heart failure (NG 106)1 were presented by Dr Abdallah Al-Mohammed (Sheffield Teaching Hospitals). It was fascinating to hear Dr Al-Mohammed describe his work on producing the guidelines with respect to what recommendations the authors are permitted to include and how recommendations may be presented. Key changes include the removal of a history of a previous myocardial infarction from the initial assessment of a patient with suspected chronic heart failure. Other changes include the guidelines now using the te

Introduction  Heart failure is a complex clinical syndrome and is the only cardiovascular disease that is increasing in prevalence.1 It has a profound impact on both the patient’s quality of life and functional capacity, as well as causing premature death.2 Traditionally, cancer patients have been the main focus for specialist palliative care services, though it is increasingly well-recognised that chronic heart failure is equivalent to malignant disease,3 with patients experiencing debilitating physical symptoms, as well as psychosocial and spiritual problems. Despite the growing recognition of the palliative care needs of this complex gr

Professor Miriam J Johnson Overcoming barriers The misunderstanding that palliative care is only for those in the last few days or weeks of life, only to be implemented once all other options are gone and irreversible deterioration is certain, forms a major barrier to access to palliative care. Attempts to identify a prognostic tool to identify when palliative care should be employed have failed, and the consensus is that a problem-based approach is more fit for purpose.11–12 Such a model would enable the “concerns of today” facing the patient to be addressed in the context of the management options appropriate at their stage of disease

Introduction Landmark qualitative studies published within the last decade highlighted inequalities in end-of-life care between people with advanced heart failure (HF) and cancer.1-8 A palliative approach and access to specialist palliative care (SPC) services for people with advanced HF is now underlined in national and international policy.9-14 However, those with HF are still more likely to die in hospital in the UK than cancer patients,15 and UK 2010 national audit figures document less than 4% of people with HF referred for palliative care.16 Hospice referral seems higher in the USA and Canada.17,18 We have previously reported retrospect

We reviewed the use of DS1500 applications for state financial benefits for patients dying from cancer (n=54) and heart failure (n=24) in one primary care practice. There was a marked inequality in favour of those with cancer, both in terms of DS1500 application form usage (cancer 33% versus heart failure 0%), but also access to palliative care service referrals (cancer 54% versus heart failure 8%) and discussion in Gold Standards Framework practice meetings (cancer 61% versus heart failure 4%). There should be equal provision of a ‘gold standard’ of care for patients with terminal disease irrespective of aetiology. Background High-qualit