Heart Failure: When the Pump is Not Pumping Well

The word “heart” carries many meanings and connotations, probably because our physical heart is essential to our lives and well-being. The heart is a pump that delivers nutrients and water to every corner of the anatomy.

Heart failure, often called congestive heart failure (CHF), occurs when the heart’s pumping action cannot meet the body’s needs. When the pump is not working well, fluid can build up. Common symptoms are shortness of breath due to fluid in the lungs and fluid under the skin (edema,) especially in the legs or in the back and bottom of bedbound people. Other symptoms include fatigue, an irregular heartbeat and cough.

The most common causes of heart failure in the USA are coronary artery disease and hypertension. Other causes include leaky or tight heart valves, alcohol excess, drug use, and heart infections. Diabetes and obesity are commonly liked to heart failure, too.

According to the Centers for Disease Control and Prevention (CDC) about 6.2 million Americans have heart failure. Approximately 290,000 people n the U.S. die with or due to heart failure each year, as reported by Emory University.

We are fortunate that we live in an age with many remarkable medications and devices that can decrease the stress on the heart so it can pump more effectively. People are living longer and more fully with heart failure.

However, for many people, despite the best treatment, heart failure gradually worsens over the years. When symptoms like trouble breathing cannot be controlled with modern heart failure medications, palliative care may be considered. Elizabeth Palliative Care is an integral part of the service offering at The Elizabeth Hospice. This medical approach focuses on providing patients relief from the symptoms, pain and stress of chronic conditions like heart failure. Working with your primary care physician and other physicians, the palliative care team provides an added layer of support.

The palliative team will facilitate discussions about care goals with patients, family members, doctors, nurses and others. This is an opportunity for everyone to assess what is working, what is not working, what is helping and what is causing more harm than good. Sometimes, people realize that they do not want to go to the hospital anymore but do want to continue aggressive treatments at home and in the doctor’s office.

When end-stage heart failure is reached, patients will have shortness of breath at rest or with minimal exertion, such as taking a few steps. Often, aggressive heart failure treatments and intensive care hospitalizations become more burdensome than helpful.

For those who are tired of repeated hospitalizations that sometimes do more harm than good, hospice care from The Elizabeth Hospice is an option. As the largest nonprofit hospice provider in San Diego County and Southwest Riverside County, we offer a comprehensive program that goes beyond managing symptoms and relieving pain. We become our patients’ trusted companions and customize the comfort care experience to meet their unique needs and wants. Our focus is not on the illness but on embracing experiences that bring meaning and joy to a person’s life.

The Elizabeth Hospice provides all the necessary durable medical equipment, like walkers, hospital beds and bedside commodes, as well as hospice-related medicines. Each patient is placed under the care of an interdisciplinary team comprised of a hospice doctor or nurse practitioner, registered nurse case manager, social work, home health aide and spiritual counselor.

We often use oxygen, very low-dose morphine and common heart medicines to help people with end-stage heart failure live their lives to the fullest. We are experts at giving the right amounts to diminish shortness of breath.

Some people with severe heart failure cannot leave the hospital without specialized heart medications given by infusion. Unlike most hospices, The Elizabeth Hospice accepts these patients so that they can spend their last days at home, in a comfortable environment, surrounded by their loved ones.

Our team brings expertise, compassion and innovation to all the patients and families we treat. Patients will literally be able to breathe more easily and family members will have the freedom to relax and be loving family members, with the burdens of planning many of the details of nursing and medical care lifted off their shoulders. To find out how your loved one who has been diagnosed with heart failure can benefit from palliative care or hospice care, contact The Elizabeth Hospice at 800.797.2050.

By George Delgado, MD, Chief Medical Officer, The Elizabeth Hospice