The heart failure patient journey often ends with multiple CHF exacerbations, some of which may involve hospital admission. Many of these patients are also elderly, with multiple comorbidities that complicate their management. Indeed, as Johann Bauersachs (Hannover) reminded the audience, much of the evidence-based management does not take account of the challenges of managing symptoms in the elderly, frail adult with low blood pressure, hyperkalaemia and renal dysfunction. He illustrated his talk with a case study and provided his thoughts on optimal management. He also gave the audience the ‘heads-up’ on the newly designed DIGIT-HF trial which seeks to provide an answer to the use and potential benefit of digitoxin in advanced heart failure. ICDs have a place in the optimal management of heart failure but present us with challenges in knowing when and how to deactivate the device at the end-of-life.
Wilhelm Haverkamp (Berlin) reminded the audience of the legal requirements around deactivation of the ICD and the need to be aware of those relevant to the individual country of practice. He challenged the audience to consider the professional skills, particularly of communication, required to discuss deactivation of the ICD with the patient and their family.
Continuing the theme of communication, Ekaterini Lambrinou (Nicosia) challenged the audience to consider the psychosocial needs of the patient and family and to address not only the physical needs but to include the emotional and spiritual.
The session was brought to an end by Christiane Angermann (Wurzburg) who provided practical advice on how to recognise the patient who may be nearing the end-of-life. She reminded us of the important interaction between symptoms, psychological distress and quality of life and the need for timely palliative care and anticipatory care planning.
There is a continuing need to increase our understanding of how best to manage symptoms, both physical and emotional, in advanced heart failure and at the end-of-life. Along-side this we need to continue to optimise the knowledge and skills of all healthcare professionals to provide such care. This session provides some support for this and so I encourage you to review the accompanying slide sets.