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The Dutch multidisciplinary guideline 'Palliative care for patients with heart failure'

Session Poster Session 2

Speaker Marjan Aertsen

Event : Heart Failure 2019

  • Topic : cardiovascular nursing and allied professions
  • Sub-topic : Cardiovascular Nursing and Allied Professions - Other
  • Session type : Poster Session

Authors : MSA Aertsen-Van Der Kuip (Utrecht,NL), YMP Engels (Nijmegen,NL), CMHB Lucas (Leiderdorp,NL), A De Graeff (Utrecht,NL), CW Middeljans-Tijssen (Doetinchem,NL), R Starmans (Den Haag,NL), MWF Van Leen (Breda,NL), J Van Erp (Den Haag,NL), R Tabak (Nijmegen,NL), L Bellersen (Nijmegen,NL)

MSA Aertsen-Van Der Kuip1 , YMP Engels2 , CMHB Lucas3 , A De Graeff4 , CW Middeljans-Tijssen5 , R Starmans6 , MWF Van Leen7 , J Van Erp8 , R Tabak2 , L Bellersen2 , 1Diakonessen Hospital Utrecht - Utrecht - Netherlands (The) , 2Radboud University Medical Centre - Nijmegen - Netherlands (The) , 3Alrijne Hospital - Leiderdorp - Netherlands (The) , 4University Medical Center Utrecht - Utrecht - Netherlands (The) , 5Slingeland Hospital - Doetinchem - Netherlands (The) , 6General Practice Center Vaillantplein - Den Haag - Netherlands (The) , 7Ruitersbos, Elderly care - Breda - Netherlands (The) , 8Dutch Heart Foundation - Den Haag - Netherlands (The) ,


Although the mean survival of patients with advanced heart failure is even shorter than of patients with cancer, and their symptom burden higher, less receive palliative care. Therefore, we developed a multidisciplinary guideline.

The guideline was developed by the Netherlands Comprehensive Cancer Organisation and experts, representing patients as well as all relevant professional associations. Using a survey, the most important barriers were collected from professionals and patients. This resulted in six topics, which were studied in depth. Based on systematic reviews, literature searches and consensus, recommendations were made regarding prognosis, palliative care provision, advance care planning, communication, organisation of care and medication in the terminal phase.

There are no practically applicable prognostic models to estimate survival. The Surprise Question, SPICT indicators and RADPAC tools are recommended for timely identifying palliative care needs. Regarding advance care planning in end stage heart failure, specific attention is needed for ICD deactivation. The use of carefully titrated heart failure medication and morphine can be beneficial for symptom relief. In the organisation of care, the coordinating role can be taken by the heart failure nurse, who can also manage the contacts with the general practitioner and home care.

In February 2018, the multidisciplinary guideline for palliative care for patients with heart failure NYHA classification III and IV was published and is currently successfully implemented. This Dutch guideline might also inspire researchers and professionals from other countries. Therefore, an English summary is available.

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