Evaluación holística de las necesidades paliativas de los pacientes con insuficiencia cardiaca avanzada

Background and objectives: Patients with heart failure (HF) have physical and emotional symptoms, spiritual and intellectual concerns, specially in end-stage HF. Frequently, these needs are unknown by health care professionals attending these patients. This could influence decisions about end of life care. Our objective was to assess information about needs and preferences in these patients and the medical assistance received to manage them. Material and methods: This was a descriptive, observational and cross-sectional study using a survey with different questions and validated Spanish questionnaires. We interviewed 32 patients with advanced HF that were admitted in the Internal Medicine Service due to an acute decompensation of HF. Results: Most frequent physical symptoms were insomnia (75░%), tiredness (50░%) and decreased feeling of well being (50░%). Anxiety was present in 9 patients (28,1░%), depression in 6 (18,8░%) and both symptoms in 7 (21,8░%). A total of 30 patients (93,8░%) had not talked about spiritual needs with their doctor. Twenty-four (75░%) patients expressed a wish to have cardiopulmonary resuscitation if needed, although only one had talked about this during admission. Twenty-six patients (81,3░%) had not received any information about their evolution and prognosis of HF. Twenty-one patients (65,5░%) expressed a wish to receive information about end-stage HF. Conclusions: An integral evaluation of patients with advanced HF must form part of the medical assistance. Early doctor-patient communication regarding needs and preferences of these patients will enable an adequate planning of end-of-life care.