Patients Perceptions About Factors Affecting Quality Of Life
Patients believed that their health status, psychological factors, economic status, social factors, spirituality, and health-related behaviors affected their QOL. Health status included physical symptoms and physical condition. Economic status primarily included the impact of heart failure on finances. Social factors included social support and social activities. Spirituality was related to faith in God and praying. Health-related behaviors were primarily self-care activities.
Health status
Physical symptoms
Patients perceived that physical symptoms such as shortness of breath and chest pain had a negative impact on their QOL. the quality of life, you know, to not have shortness of breath, not have chest pain, to not have all of the things that would affect your daily living. Another patient also reported that physical symptoms such as shortness of breath, fatigue, and nausea impaired his QOL.
Like being out of breath affects my quality of life because that limits how much energy I have to do anything and also haveI dont know how much directly related to my heart failure or not, but I have constant battle with nausea.
Physical condition
Psychological factors
Mood
Positive outlook
Many patients perceived that maintaining a positive perspective or attitude helped them maintain a good QOL.
Economic status
Social factors
Social support
Social activities
Spirituality
Health-related behaviors
What Are The Symptoms Of End
Heart Failure: Quick Facts
1. More than 6 million U.S. adults have heart failure.
2. About half of people who develop heart failure die within 5 years of diagnosis.
3. Most people with end-stage heart failure have a life expectancy of less than 1 year.
4. The leading causes of heart failure are diseases that damage the heart, such as heart disease, high blood pressure, and diabetes.
Heart failure worsens over time, so symptoms are most severe during the final stages. It causes fluid to build up in the body, which produces many of these symptoms:
- Shortness of breath . In the final stages of heart failure, people feel breathless both during activity and at rest.
- Persistent coughing or wheezing. This may produce white or pink mucus. The cough may be worse at night or when lying down.
- Weight gain or swelling of the feet, ankles, legs, abdomen, or neck veins.
- Tiredness, weakness.
In addition, people in the final stages of heart failure may suffer from:
- depression, fear, insomnia, and isolation
- anxiety about their future
- trouble navigating the health care system
What Can You Do If You Have Heart Failure
Heart Failure is a serious disorder and is usually a chronic illness. Many forms of Heart Failure can be controlled with medication, lifestyle change and correction of any underlying disorder. The success of your treatment plan depends on your active involvement. Following your treatment plan can make you feel better, prevent your Heart Failure from getting worse and help you live longer.
What you can do:
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How Heart Failure Changed Our Lives
Twelve years ago, when she was 40 years old, Kim was working as an ER nurse at a local hospital. She had been a nurse for 16 years. She was about to leave home for work but forgot something upstairs. When she got to the top of the stairs, she couldnt catch her breath. Kim thought this was strange but brushed it off. She went to work to pull a 12-hour shift.
During a change of shift report at work, Kim became ill. She was short of breath and had palpitations in her chest. She felt like she would pass out. Her coworkers assisted her to a stretcher. The ER nurse had become the patient.
After a workup, Kim was advised to follow up with her primary care provider . She told her PCP about how she recently had trouble breathing while climbing stairs and slight swelling in her ankles.
Her PCP referred her to a cardiologist who ordered a battery of tests, including a treadmill stress test and an echocardiogram. She failed both tests. She couldnt even complete the treadmill test because she was so short of breath.
After the testing, the cardiologist told Kim she had congestive heart failure. Congestive heart failure is when the heart is unable to pump effectively to meet the bodys needs. This results in symptoms such as shortness of breath, fatigue, ankle swelling, and even a cough.
At first, Kim was convinced the cardiologist was wrong. She had no other health issues and worked out regularly.
Last medically reviewed on September 11, 2020
Esc Guidelines For Heart Failure
What patients need to know
This guide for patients from the European Society of Cardiology aims to provide an overview of the latest evidence-based recommendations for the diagnosis and treatment of heart failure.
In particular, it should help patients to understand the:
- main types of heart failure
- medicines used to treat heart failure
- devices that may be appropriate
- importance of rehabilitation
- management by a multidisciplinary team
- importance of self-care in managing your own condition
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When Can I Return To Work
If you have been in the hospital for your heart failure, your doctor will tell you how soon you can return to work after you go home. Your return to work will be based on your overall health, symptoms, and your rate of recovery.
You should try to work as long as you are able. If you have a job that requires a lot of physical work, you may need to change some of your job-related activities. This may involve job re-training or taking disability.
Talk to your doctor about the type of job you have. Your doctor can help you decide if your job will affect your heart condition and if you need to make changes.
The following tips should make your transition back to work easier.
- Plan periods of rest. Be sure to get plenty of rest. You may need to plan at least one rest period every day. When you rest, keep your feet up to keep the swelling in your legs down.
- Conserve your energy. Using less energy with daily tasks can help you have more energy to do more activities during the day. You may need to cut down on some of your activities or use energy-saving devices or techniques. If daily self care or home care activities are too tiring, tell your doctor.
Recognizing Depression And Anxiety
Everyone feels anxious or blue some of the time. But if these feelings persist and they interfere with your ability to do and enjoy daily activities, or if your relationships are affected, you should seek help. People who are depressed often feel tired and have no energy. They may lose interest in sex, have trouble sleeping and lose their appetite. Although fatigue and loss of appetite are also common symptoms of Heart Failure, they are more likely due to depression if accompanied by any of the symptoms listed on the next page. You may be depressed if you have any of the following symptoms for more than 2 weeks:
- Excessive sleepiness
- Feeling keyed up or always on edge
- Restlessness
- Feeling shaky
Many people in our society feel there is some stigma associated with having emotional problems like depression or anxiety. As a result, they may be reluctant to talk to anyone about how they are feeling. However, having emotional problems is nothing to be ashamed about. It is important to recognize and treat depression and anxiety. If you are having difficulty coping with feelings about Heart Failure, you should seek help and support. In other words, if depression and anxiety are interfering with your life or causing distress, it is important for you to seek help from your doctor or nurse.
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Supporting Those Around The Patient
Those close to the patient may also need emotional and practical support. They may need:
- information about heart failure to help them understand the symptoms and treatment options
- support if they’re caring for the patient
- time to relax or look after their own health.
If the patient’s heart failure is due to an inherited heart condition, their family may have concerns about their own health. Talk to them about their worries. It might be appropriate to refer immediate family members to a clinic which specialises in inherited heart conditions. This may have been done when the patient was first diagnosed.
Inherited heart conditions services offer specialist assessment and investigations, genetic counselling and testing. GPs can refer to this service.
What Are Treatment Options For Heart Failure
Heart failure requires a lifelong management regimen. Several drugs may be prescribed to treat congestive heart hailure, depending on the patients type of heart failure and severity of the symptoms. They include:
- angiotensin-converting enzyme inhibitors, which boost blood flow by widening blood vessels
- b-blockers, which slow the heart rate and cut hypertension
- digitalis, which helps the heart contract more strongly
- diuretics, which promote urination to prevent fluid retention in the body and especially the lungs.
Bypass surgery can help if blocked arteries are leading to heart failure, and heart valve replacement may also correct another leading cause. In extreme cases, patients will receive a heart transplant.
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Maintain A Healthy Weight
Taking steps to lose weight or working to maintain your current weight can help reduce extra strain on your heart. Changing your diet and adding exercise to your routine can help you lose or maintain weight.
Losing weight is easier said than done, especially if youre struggling with fatigue or shortness of breath. Even if progress is slow, remember that a small amount of weight loss can have benefits. Always talk with your doctor before starting a new diet or exercise regimen. Some popular diet or exercise plans may not be appropriate for your health needs.
Support Them To Make Decisions About Treatments
As well as having an advance care plan, patients should be given the chance to discuss the following issues:
- Whether to deactivate an implantable cardioverter defibrillator , if they have one. This can prevent the ICD activating at the end of life, which can be distressing.
- What the patient would want to happen if they had a cardiac arrest. They may decide they do not want to have cardiopulmonary resuscitation .
- When to stop medication that no longer reduces symptoms or improves their quality of life. This can be a difficult conversation and it’s best carried out sooner rather than later. Make sure the patient and the people important to them understand what changes are being made to their medication and why.
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Symptoms Of Heart Failure
Common symptoms of heart failure include:
- breathlessness either when resting or being active
- swelling of legs, ankles, feet, abdomen or around the lower back area
Patients with heart failure may find it difficult to move around, do daily activities, work and do hobbies. This can affect how they feel, and lead to worries about money or losing their independence.
If someone has symptoms of heart failure and they have not been diagnosed with heart failure, it’s important that they speak to their GP or another healthcare professional.
Prognosis At Each Stage
The outlook for CHF varies greatly between people, as there are many contributing factors for every individuals situation. However, generally speaking, if CHF is discovered in its earlier stages and properly managed, you can expect a far better outlook than if its discovered much later.
Some people whose CHF is discovered early and treated promptly and effectively can hope to have a nearly standard life expectancy.
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When To Seek Hospice Care
Even physicians have difficulty determining life expectancy for people with end-stage heart-failure. The condition can be unpredictable, and symptoms can change. However, certain signs can indicate that hospice care would be beneficial, including:
- frequent chest pain
- significant fatigue or shortness of breath
- substantial decline in ability to do daily activities, such as self-care
- The patient has already received the best possible treatment, which are no longer working well, and the patient is not a candidate for other interventions.
- The patient has received the best possible treatment and has decided to decline further specialized interventions.
People can be reluctant to start hospice, as they may worry it means theyre giving up or that it will hasten death. But such concerns are unfounded. In fact, patients and families often wish they had started hospice sooner, because it makes such a positive difference in their lives. And research shows that early admission to hospice results in greater satisfaction with care among patients and family caregivers.
Get Support And Know Your Options
Living with heart failure may cause fear, anxiety, depression, and stress. Talk to your healthcare provider or a professional counselor. They can help you find or learn ways to cope.
- Get treatment for depression. If you are depressed, your provider may recommend medicines or other treatments that can improve your quality of life.
- Join a patient support group. You can learn how other people who have similar symptoms have coped with them. Your provider may be able to help you find local support groups, or you can check with an area medical center.
- Seek support from family and friends. Letting your loved ones know how you feel and what they can do to help can help lower your stress and anxiety.
Know your treatment options. If your heart failure is very serious, palliative or hospice care can improve your quality of life and help make your daily life more comfortable. This type of care focuses on managing your symptoms, helping you avoid unnecessary tests or treatments, and providing support to your loved ones.
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Treating The Underlying Causes
A number of conditions can contribute to heart failure. Treatment of these other factors may range from surgery or angioplasty to open clogged blood vessels in patients with coronary artery disease to medications prescribed to control high blood pressure, diabetes, anemia or thyroid disease. In addition, it’s particularly important to treat abnormal heart rhythms called arrhythmias in patients with heart failure.
Treatments For Heart Failure
Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition.
Common treatments include:
- lifestyle changes including eating a healthy diet, exercising regularly and stopping smoking
- medication a range of medicines can help many people need to take two or three different types
- devices implanted in your chest these can help control your heart rhythm
- surgery such as valve surgery a bypass operation or a heart transplant
Treatment will usually be needed for life.
A cure may be possible when heart failure has a treatable cause. For example, if your heart valves are damaged, replacing or repairing them may cure the condition.
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How Is Heart Failure Diagnosed
To make the diagnosis of Heart Failure the following should be done:
- Health History.
- Physical Exam.
- Chest X-Rayto evaluate the size and shape of the heart and detect any fluid in the lungs.
- EKGto determine heart rhythm and search for previous heart damage or thickened heart muscle.
- Blood Test for BNPa hormone made when the heart is overworked.
- Measure Ejection Fraction to gauge effectiveness of the pumping action of the heart. The EF can be determined with an echocardiogram, nuclear scan or angiogram.
Left Ventricular Assist Devices
These may be implanted in the chest to increase heart pumping action. Until recently, LVADs required that the patient be hooked up to a large, hospital-based console while awaiting a transplant. Miniaturized battery-powered LVAD units, however, are allowing many patients to leave the hospital. The devices may be used as a primary treatment or as a bridge to heart transplant in adults.
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What Will Happen Towards The End
Heart failure usually gets gradually worse over time. It may eventually reach a point where it becomes very severe and it’s unlikely the person will live much longer.
Palliative care will usually begin when heart failure reaches this stage.
This involves treatment to help you feel as comfortable as possible, as well as being offered psychological, spiritual and social support for both you and your family.
You can choose whether you want palliative care and where you’d like it to be provided.
Care can be provided:
Life After A Heart Failure Diagnosis
Life after a heart failure diagnosis can look very different, and you may feel unsure of the road ahead.
You can still live a life that you love and enjoy and wed like to help you.
Visit our Living with a Heart Condition section for more information about how to manage your condition at home, how to stay well and how to rebuild your future.
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How Can I Prevent Heart Failure
You can prevent heart failure by preventing coronary heart disease and heart attack. The best way to do this is to reduce or eliminate the risk factors that lead to heart failure. You could:
- drink alcohol in moderation
- reduce stress and look after your mental wellbeing
If you have had a heart attack, its even more important to manage your risk factors and follow your treatment plan. Make sure you check in frequently with your healthcare team.
Some risk factors such as your age, whether you have other health conditions, or your genes may be outside your control. Speak with your doctor if you have concerns about developing heart failure, and how you can manage it.