Provision of palliative care for chronic heart failure inpatients: how much do we need?

Background: Clinical guidance recommends early CHF palliative care intervention, but the magnitude of need is unknown and evidence-based referral criteria absent.This study aimed to: 1) Measure point prevalence of inpatients appropriate for palliative care. 2) Identify patient characteristics associated with palliative care appropriateness.

Meeting the communication and information needs of chronic heart failure patients.

There is a lack of evidence on how best to meet policy guidance in fulfilling the information needs of patients with chronic heart failure (CHF) and their families. We aimed to generate guidance for appropriate information provision to CHF patients and their families through a cross-sectional qualitative methodology with constant comparison of emergent themes. Participants were 20 CHF patients (New York Heart Association Functional Classification III, III-IV, and IV); 11 family carers; six palliative care staff; and six cardiology staff.

Modelling services to meet the palliative care needs of chronic heart failure patients and their families: current practice in the UK.

Objective: To describe current provision of specialist palliative care for chronic heart failure (CHF) patients, and explore challenges, referral criteria and recommendations to inform service development.

Method: Semi-structured qualitative telephone survey of key professionals involved in CHF palliative care in the UK.

Results: Twenty telephone interviews were conducted with staff from 17 services comprising three main types: hospital-based (n = 7), community-based (n = 6) and hospice-based (n = 4).

Improving end-of-life care for patients with chronic heart failure: "Let's hope it'll get better, when I know in my heart of hearts it won't".

Background: Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life.

Aims: (1) To formulate guidance and recommendations for improving end-of-life care in CHF; (2) to generate data on patients' and carers' preferences regarding future treatment modalities, and to investigate communication between staff, patients and carers on end-of-life issues.

Design: Semistructured qualitative interviews were conducted with 20 patients with CHF (New York Heart Association functional classification III-IV), 11 family carers, 6 palliative care clinicians and 6 cardiology clinicians.

Managing patients with non-ST-segment elevation acute coronary syndrome.

Acute coronary syndromes (ACSs) can be described as ST-segment elevation or non-ST-segment elevation, including unstable angina. Traditionally, ST-segment elevation ACS has been considered to be more serious, but non-ST-segment elevation ACS has higher mortality rates in the longer term. This article discusses diagnosis, including history taking, clinical examination, electrocardiogram and biochemical markers that help to differentiate between types of non-ST-segment elevation ACSs.

B-type natriuretic peptide testing in a nurse-led heart failure clinic.

Heart failure has a significant impact on health and its prevalence increases with age (Cowie et al, 1997). Coronary heart disease (CHD) and hypertension are the most common causes (Cowie et al, 1999). The National Service Framework for Coronary Heart Disease identifies that people with suspected heart failure should be offered appropriate investigations to confirm the diagnosis and identify the cause (DoH, 2000).