Multidisciplinary Team-Based Palliative Care for Heart Failure and Food Intake at the End of Life |
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| Authors: | Tatsuhiro Shibata Kazutoshi Mawatari Naoko Nakashima Koutatsu Shimozono Kouko Ushijima Yumiko Yamaji Kumi Tetsuka Miki Murakami Kouta Okabe Toshiyuki Yanai Shoichiro Nohara Jinya Takahashi Hiroki Aoki Hideo Yasukawa Yoshihiro Fukumoto |
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| Affiliation: | 1.Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (T.S.); (K.M.); (K.S.); (K.O.); (T.Y.); (S.N.); (J.T.); (H.Y.);2.Kurume University Hospital Palliative Care Team, Kurume University, Kurume 830-0011, Japan; (N.N.); (M.M.);3.Department of Nursing, Kurume University Hospital, Kurume 830-0011, Japan; (K.U.); (Y.Y.); (K.T.);4.Cardiovascular Research Institute, Kurume University, Kurume 830-0111, Japan; |
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| Abstract: | Traditionally, patients with end-stage heart failure (HF) have rarely been involved in end-of-life care (EOLC) discussions in Japan. The purpose of this study was to examine the impact of HF-specific palliative care team (HF-PCT) activities on EOLC discussions with patients, HF therapy and care, and food intake at the end of life. We retrospectively analyzed 52 consecutive patients with HF (mean age, 70 ± 15 years; 42% female) who died at our hospital between May 2013 and July 2020 and divided them into two groups: before (Era 1, n = 19) and after (Era 2, n = 33) the initiation of HF-PCT activities in June 2015. Compared to Era 1, Era 2 showed a decrease in invasive procedures, an increase in opioid and non-intubating sedative use for symptom relief, improved quality of meals at the end of life, and an increase in participation in EOLC discussions. The administration of artificial nutrition in the final three days was associated with non-ischemic cardiomyopathy etiology, the number of previous hospitalizations for HF, and multidisciplinary EOLC discussion support. HF-PCT activities may provide an opportunity to discuss EOLC with patients, reduce the burden of physical and psychological symptoms, and shift the goals of end-of-life nutritional intake to ensure comfort and quality of life. |
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| Keywords: | heart failure palliative care end-of-life care discussion advance care planning food intake artificial nutrition |
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