Last Days Congestive Heart Failure

What To Leave Behind

When you start to plan ahead for the end of your life it can be quite normal to start thinking about the life that youve lived and the experiences that youve had and shared with others. You may also think about unresolved issues or try to make amends. Some people want to leave things behind to their family or friends as a way of expressing their feelings. You could:

• Create a memory box or a photo album that brings back good memories. You can do this on your own or with your partner, family, friends, children or grandchildren.

• Record voice messages on your phone or computer.

• Make a video on your phone or computer.

Lasting Power Of Attorney

A lasting power of attorney is a legal document where you appoint one or more people to help you make decisions or to make decisions on your behalf. This gives you more control over what happens to you if you are unwell and unable to make your own decisions.

• Find out more about making a lasting power of attorney.

How Long Does End

Life expectancy and remedies
Left ventricular assist device or a heart transplant	1 to 3 years

Normally, when one has end-stage heart failure, their maximum life expectancy is around a year, and the minimum is around 6 to 9 months. When people try methods like left ventricular assist devices or getting a heart transplant to prolong their life, they can live around 1 to 3 years sometimes, but that is only around 50 to 60 percent of the people who get them. Heart failure is technically defined as the weakening of the heart, and this will slow down the heart bit by bit. This will make it hard for the heart to pump blood to all the other parts of the body as it actually should.

Though the heart starts weakening a long time before it shows symptoms, it can change first to try and pump blood like it used to. The heart might enlarge, stretch, or even pump more faster than it should. Normally, the heart beats about 60 to 100 times every minute if its normal.

Since the symptoms dont show themselves until it becomes serious, some people might not even notice they have heart issues until its very late. When the person doesnt know, it tends to get weaker and weaker as days pass by until the symptoms start showing.

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Hospice Care For Heart Disease Patients

If you are reading this, it is likely you or someone you love has been waging a difficult physical and emotional battle against heart failure or some form of heart disease. Your search for comfort, support and answers does not stop when you accept that you must learn to live with heart disease. Thats when VITAS can help.

Hospice helps patients and their families deal with the significant impact of heart disease after curative treatment has stopped. On this page, weve provided answers to these questions:

• When is the right time to ask about hospice?
• What can hospice do for a person with heart disease?
• What can hospice do for the family of a person with heart disease?
• What are the overall benefits of hospice care?
• How can I approach my hospice discussion with family members and loved ones?

How Palliative And Hospice Care Can Help With End

Both palliative and hospice care focus on the whole person, including their physical, emotional, social, and spiritual needs. The main difference is that palliative care can be given at any time during a serious illness, and hospice care is given near the end of life typically when a persons prognosis is six months or less.

Palliative and hospice care can also provide help with making difficult treatment decisions, such as whether to be resuscitated if the persons heart stops, or whether to have a tube placed in their throat to help them breathe.

Similarly, people with end-stage heart failure may need to decide when to disable certain medical devices implanted in their body:

• Implantable cardioverter defibrillator . Patients can have the shock function turned off, or not replace the battery when the current one runs out. Electrical shocks from ICDs can cause unnecessary distress for patients and loved ones at the end of life.
• Left ventricular assist device . Typically, the patient decides when this heart pump will be shut off before it is implanted. The decision can be discussed again as the end of life nears.

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What Are The Symptoms

Some are easy to confuse with normal aging or other diseases. The more advanced your heart failure, the more likely you are to have many symptoms, or the changes that youâve noticed in yourself will worsen.

These are common ways that heart failure can affect you:

Shortness of breath. Heart failure can make it hard to breathe when you walk up a flight of stairs. With advanced heart failure, you may get winded in a shorter period of time, or you may have trouble even when youâre sitting still.

Sleep problems. Heart failure can make it hard to breathe or catch your breath when you lie in bed. You may have trouble nodding off to sleep, or you might wake up in the middle of the night gasping for air. Try sleeping while propped up on two or more pillows instead of lying flat. Advanced heart failure makes it even more likely youâll have trouble breathing when youâre at rest. That means your bedtime problems will probably get worse, too.

Coughing. You may already have a dry cough that acts up when youâre lying in bed. You might cough often during the day, and your phlegm could have a slight pink tint to it. That means thereâs a bit of blood in the gunk youâre coughing up. Advanced heart failure can make that cough worse, especially when youâre lying down.

Fatigue. Heart failure can make you feel worn out. Things that wouldnât have tired you out in the past suddenly do. Youâre more likely to feel tired all of the time with advanced heart failure.

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Is My Loved One Eligible For Care Heres When To Call Hospice For Heart Failure Heart Disease And Chf

• End-stage heart disease, advanced heart failure and congestive heart failure symptoms to look for: chest pain, shortness of breath, cognitive decline, increased confusion, recurrent hospitalization for heart-related condition, treatment resistant dysrhythmias, fatigue, unintentional weight loss, significant limitations in physical activity, loss of appetite, anxiety, lightheadedness, fluid retention and/or swelling and increased sleeping.
• The presence of other chronic disease or conditions such as diabetes or chronic pulmonary obstructive disease may also be a factor in determining eligibility for hospice care
• A prognosis of 6 months or less, if the disease takes its regular scientific course. No one really knows a definite timeframe.
• Curative treatment is no longer the patients choice or option.
• Comfort care, symptom management, and goals of care are the primary focus.

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What Are The Symptoms Of Heart Failure

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesnt mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe, and may come and go.

In general, heart failure gets worse over time. As it worsens, you may have more or different signs or symptoms. It is important to let your doctor know if you have new symptoms or if your symptoms get worse.

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How Can I Approach A Hospice Discussion With Family Members And Loved Ones

The final months of life are frequently marked by strong emotions and hard decisions. Talking about hospice, even with those closest to you, can be difficult. Here are some tips to get the discussion started.

For patients speaking to families

Education is key. Educate yourself first. By now, youve probably done some research online. It may be helpful to read and share Considering Hospice: A Discussion Guide for Families at HospiceCanHelp.com. This discussion guide is a tool for you to print out and use in a family discussion.

Determine what your family members know. Before bringing up hospice, make sure your family members and caregivers have a clear understanding of your health status. People handle difficult information in different ways. If family members do not accept or understand your prognosis, ask your physician, clergy, a VITAS social worker or a trusted friend to speak with them on your behalf.

Discuss your goals for the future, as well as theirs. As a patient, your greatest concern might be to live without pain, to stay at home or not to be a burden. Ask your family members/caregivers about their concerns as they consider the coming days, weeks and months. Explain that hospice is not giving up. It is an active choice to ensure that everyones needs are met.

For families speaking to patients

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Taking Care Of Yourself

Knowing youre coming towards the end of your life can be scary and upsetting. You may even feel angry. You might find that these feelings are made worse by the constant coverage of the coronavirus pandemic and the discussions about death on the news as well as the unknown, and the thought of leaving family and loved ones behind.

• Visit our emotional support hub to get help for anxiety, depression and loneliness.

It can really help your mental wellbeing to keep a sense of structure in your life and practice self-care. Depending on your symptoms and how youre feeling, you might not feel up for doing this. But if you can, try to:

• do gentle activity exercise if you can, or try to move about

• do things you enjoy hobbies/reading/watching TV

• keep in contact with family and friends via telephone or social media.

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What You Can Do

Some risk factors of heart failure, like age, cant be modified. Still, people with CHF can take steps to improve the long-term prognosis. The first thing to do is to be familiar with any family history of heart disease. You’ll also want to learn about all the possible symptoms. Don’t ignore any symptom that you think is cause for concern. Tell your healthcare provider about them right away.

Regular exercise, along with managing any other health issues you may have, can also help to keep CHF under control.

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Strengths And Limitations Of The Study And Method

Our study has a consistent and in-depth focus on the patients perspective. A major strength is the inclusion of very old patients . It is in the nature of qualitative studies to have a small number of participants. Therefore, the findings cannot be generalised, but they provide specific in-depth insights into the perception and personal experience of old and very old patients with severe heart failure. The patients were only recruited in an inpatient setting at two geriatric hospitals and not in general practice or other outpatient settings. Furthermore, the tendency towards socially desirable statements must be considered. To reduce social bias, the interviewer was not involved in the delivery of health care for the patients and was not employed by either of the geriatric hospitals.

When Should We Consider Hospice Care For Chf

Hospice can be appropriate for many types of end-stage heart disease, including heart failure, valvular heart disease and coronary artery disease. Regardless of the type of heart disease, hospice is a fitting choice when an individual begins to experience persistent, severe symptoms that interfere with their daily life. Hospice care should also be considered if an individual begins to have recurrent hospitalizations or complicated hospitalizations, such as an ICU stay.

One of the earliest symptoms of a declining heart is exercise intolerance. This begins with symptoms present with significant exertion and can progress to symptoms present with doing our activities of daily living, such as bathing and dressing. At its worst, symptoms are present at rest. Heart disease, depending on the etiology, can present with other more specific symptoms, including fluid overload, chest pain, lightheadedness, shortness of breath and arrythmias. Patients may experience unintentional weight loss despite a normal appetite. As the disease progresses, cardiac output can decline, resulting in low blood pressure and poor prefusion of our vital organs. This can lead to dysfunction of further organ symptoms, such as worsening kidney function.

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Heart Failure Expectations Unrealistic

In the study, researchers surveyed 122 people with moderate to advanced congestive heart failure about their perception of their life expectancy.

They found the heart failure patients tended to overestimate their life expectancy by about three years. The average patient survival estimate was 13 years compared with a validated medical model estimate of 10 years.

Overall, 63% of people with heart failure overestimated their remaining life expectancy by an average of 40% compared with medical model predictions. Those who were younger and with more advanced disease were most likely to overestimate how long they had left to live.

During the three-year follow-up period, 29% of the people involved in the survey died. Researchers found no relationship between longer life expectancy perceptions and survival.

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Is dying of congestive heart failure painful? Pain. Some people with heart failure can experience pain or discomfort towards the end of their life. They should be assessed using a pain scale. Pain-relieving medicines can be used to relieve pain and discomfort this can include opioid and non-opioid medicines .

Signs It Might Be Time For Hospice

Patients are considered to be in the terminal end stage of heart disease when they have a life expectancy of six months or less. Only a doctor can make a clinical determination of congestive heart failure life expectancy. However, look for these common signs that the disease has progressed to a point where all involved would likely benefit from hospice services:

• The patient has advanced congestive heart failure or advanced coronary disease with frequent episodes of angina .
• The patient has an abnormal heart and suffers significant symptoms of fatigue, shortness of breath or functional decline.
• Optimal treatment for the patients condition has already been provided and he or she is not a candidate for further surgical or medical intervention.
• The patient has tried optimal treatment and made the personal choice not to pursue any further specialized treatment.

People often say, I wish I had asked about hospice sooner.1 Reports show early referral to hospice results in greater satisfaction for the patient and their caregivers. In 2015, seriously ill patients received hospice services for an average of 69.5 days, but given more time, hospice resources can supplement care provided by doctors and loved ones through a patients last six months of life.

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Treatment Options For Heart Failure

Once your vet has diagnosed your dog with congestive heart failure with a physical exam and diagnostic imaging, there will be a few treatment options that can offer your dog more time.

These management options will only be a band aid for your dogs heart disease, but can offer them much needed comfort as the condition progresses.

Some of the most common treatment options for dogs with CHF include:

What Causes Heart Failure

Heart failure can be caused by many medical conditions that damage the heart muscle. Common conditions are:

• Coronary artery disease affects the arteries that carry blood and oxygen to the heart . The normal lining inside the arteries breaks down, the walls of the arteries become thick, and deposits of fat and plaque partially block the flow of blood. Over time, the arteries become very narrow or completely blocked, which causes a heart attack. The blockage keeps the heart from being able to pump enough blood to keep your organs and tissues healthy. When arteries are blocked, you may have chest pain and other symptoms of heart disease.
• Heart attack. A heart attack happens when a coronary artery suddenly becomes blocked and blood cannot flow to all areas of the heart muscle. The heart muscle becomes permanently damaged and muscle cells may die. Normal heart muscle cells may work harder. The heart may get bigger or stiff .
• Cardiomyopathy. Cardiomyopathy is a term that describes damage to and enlargement of the heart muscle not caused by problems with the coronary arteries or blood flow. Cardiomyopathy can occur due to many causes, including viruses, alcohol or drug abuse, smoking, genetics and pregnancy .
• Tobacco and illicit drug use.
• Medications. Some drugs used to fight cancer can lead to heart failure.

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Where To Get Support

If youre finding it hard to speak to friends and family, you could phone your GP or nurse for help. At this time, nurses may have been redeployed so it might take a little longer to get in touch with them. You could also try speaking to people in a similar position to you, through online channels like Health Unlocked. You could also visit a Death Café. This sounds scary, but they are a place for people to gather and normalise conversations about death. Death Cafés arent operating due to coronavirus, but many are holding virtual meetings online instead. If you would rather get support over the phone, Soul Midwives have set up a free telephone line, available for anyone facing the end of life or caring for someone who is.

• Get support and information from Compassion in Dying.