Abstract and Introduction
Abstract
End-stage heart failure patients are a prevalent hospice population with unique symptoms. The purpose of this study was to describe the frequency, severity, and distress of symptoms experienced by heart failure patients receiving hospice care. The relationships among depressive symptoms and symptom prevalence, severity, and distress were also examined. Forty patients with end-stage heart failure in hospice provided demographic information and responses to the Memorial Symptom Assessment Heart Failure Scale and the Profile of Mood States-Depression Scale. Patients reported experiencing a mean of 12.1 symptoms (range, 0–32). The most prevalent symptoms reported were dry mouth (72.5%), lack of energy (70%), and shortness of breath (65%). Symptom prevalence was not indicative of symptom severity and/or distress. Patients endorsed an average of 8 depressive symptoms (range, 0–10). Moreover, most end-stage heart failure patients indicated that they remained hopeful. The findings of the research underscore a need for further research into the symptoms experienced by end-stage heart failure patients in hospice to optimize symptom management by clinicians.
Introduction
Heart failure (HF) patients are a rapidly emerging hospice population. Although cancer patients still comprise the largest disease group in hospices, they account for less than 50% of patients, whereas a rapidly growing population is the group with heart disease. Cardiac disease is the second most prevalent medical diagnosis, accounting for 14% of hospice admissions nationwide, with HF being the most common designation. Patients with HF endure numerous physical and emotional symptoms. Research indicates that patients experience sustained symptoms of shortness of breath, edema, dry mouth, fatigue, pain, anxiety, sadness and depression that adversely impact quality of life. Importantly, depression is a common comorbidity among HF patients that is frequently overlooked.
Symptom management in the outpatient and inpatient settings continues until end-stage disease may bring patients to a hospice. Hospice services can mitigate the infirmities of HF by focusing on symptom management. In the hospice setting, the average length of stay for HF patients (mean [SD], 54 [93] days) is longer than for cancer patients (mean [SD], 27 [37] days). This puts HF patients at an advantage in that they are better able to benefit from the management of patients' symptom prevalence, severity, and distress and support of quality of life offered by hospice team members.
In this research, symptoms from the Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF), such as fatigue, dyspnea, edema, loss of appetite, and pain, were examined. Evaluation of depressive symptoms using the Profile of Mood States-Depression Scale (POMS-D) experienced by HF patients in hospice care was included to provide a more holistic picture of the end-stage HF patient upon admission to hospice. The purposes of this study were to report the most frequent, intense, and distressing symptoms experienced by HF patients upon admission to hospice home care and to examine the relationships among depressive symptom and symptom frequency, severity, and distress.