According to a 2017 America’s Health Rankings from the United Health Foundation report, 7.4 percent of West Virginians have coronary heart disease, which is the highest percentage in the United States. Heart disease can put an individual at risk for heart failure, which occurs when the heart muscles can no longer pump effectively, and fluid builds up around the heart, abdomen, lungs and other parts of the body. Heart failure does not mean the heart has stopped working, but that the cardiac muscles are not strong enough to maintain normal circulation. West Virginia holds the highest rate of heart disease in North America with 14 percent.
Congestive Heart Failure (CHF) is a progressive cardiovascular disease, affects people of all ages, from children to the elderly. There is no cure for CHF.
In the progression of CHF, fluid around the heart builds up and kidneys receive less blood. The pressure causes swelling or “congestion” in the legs, around the eyes, lungs, liver and other areas of the body. According to the Centers for Disease Control and Prevention, roughly half of the patients who contract heart failure pass away within five years of diagnosis. Read on to learn more about the causes, symptoms, and treatments. And, as end-stage CHF approaches, WV Caring can manage the symptoms from the disease during this crucial time.
CAUSES AND RISK FACTORS OF CONGESTIVE HEART FAILURE
Heart defects are generally caused by genetics; however, other environmental and lifestyle behaviors can take place in the development of cardiovascular diseases.
Several causes of CHF include:
- Coronary Artery Disease: High cholesterol blocks coronary arteries, causing the pathway for blood to become narrow. The blood flow becomes restricted and leads to damaged arteries.
- Hypertension: Hypertension occurs when your blood pressure is higher than normal. As your arteries become more limited for space, blood pressure builds from lack of circulation causing damage.
- Valve Conditions: Valve conditions result in heart defects due to the irregularity of blood flow and the inability of your valves to open and close correctly.
- Thyroid Disorders: The thyroid gland works to regulate the body’s metabolism. The butterfly-shaped gland at the base of the neck can develop problems when there is an imbalance of hormones.
COMMON TYPES OF CHF
The most common types of CHF are systolic heart failure and diastolic failure. Certain lifestyle behaviors can provoke the development of heart failure. Additional causes include heart defects present at birth, diabetes, asthma, reduced kidney function, substance abuse, and obesity.
THE FOUR STAGES OF CHF
There are four stages to CHF. The stages are affected by lifestyle changes, additional health conditions and medications. Each stage is depicted by the severity of symptoms as they progress.
- Stage 1 or pre-CHF: You are likely to have accumulated disorders that affect the heart. Medical professionals may have noticed weaknesses developing prior to severe symptoms starting.
- Stage 2: You are experiencing minor symptoms such as normal physical activity causing fatigue, palpitations or shortness of breath. As existing heart complications slightly become more apparent, minor lifestyle changes are recommended.
- Stage 3: Symptoms are occurring regularly, and there’s a noticeable limitation of physical activity. Even mild exercise may cause fatigue, palpitations or shortness of breath.
- Stage 4 or late-stage CHF: Severe symptoms are to be felt at this stage, even at rest. Medical treatment and routine doctor visits are highly advised to manage impairing lifestyle adjustments.
SIGNS AND SYMPTOMS OF CHF
Depending on which the stage of the disease, the intensity level of signs and symptoms will vary.
Some early signs and symptoms:
- Swelling in ankles, legs and abdomen
- Weight gain
- Need to urinate while resting at night
End-stage heart failure: what to expect.
- Shortness of breath (Dyspnea): While shortness of breath is common throughout CHF (particularly while active) it becomes much more persistent towards the end-of-life. Patients start to experience dyspnea while sitting or resting as well.
- Chronic cough and wheezing: This will become more prominent and persistent, like shortness of breath, during the final months and weeks of CHF. The cough may produce wheezing along with white or pink-colored mucus.
- Swelling (Edema): Because of the heart’s inability to pump blood effectively, fluid builds up in the body and swelling occurs. This swelling happens most frequently in the legs and abdomen.
- Rapid heart rate or irregular heartbeat palpitations: The heart must work overtime to pump blood causing it to significantly beat harder and faster.
- Confusion and delirium: This can be expected with many advanced illnesses; however, CHF patients experience disorientation due to the changing sodium levels.
- No appetite: A lack of appetite is very common for patients during the end-stage of a terminal illness. Bloating, hard stomach and an upset stomach are common issues as well.
- Chest pain: CHF usually does not cause chest pain; however, other serious conditions that cause chest pain, such as angina and myocardial infarction, can coexist with heart failure.
End Stages of CHF
According to the US National Library of Medicine National Institutes of Health, one percent of the six million patients in the United States living with heart failure will reach the advanced stage of CHF and pass away due to progressive pump failure.
As congestive heart failure advances to the last stage, the physician, patient and family should consider options such as hospice care.
MANAGING ADVANCED CHF WITH HOSPICE
Living with CHF does not have to restrict your overall health and quality of life during it. Talk to your healthcare provider, ask questions and take the necessary steps to improve your health. Take the time to discuss the benefits and risks of each alternative best catered to your needs. Patients with end-stage CHF and terminal heart disease often make frequent doctor’s office, ER and hospital visits for breathing difficulties and fatigue. In fact, over one million people in the United States are admitted to inpatient settings for heart failure each year. One in four Medicare heart failure patients is readmitted to the hospital within 30 days.
Many of these hospital visits could be prevented with the support of hospice care, but cardiac patients and families are often unaware of the hospice qualifications for CHF. And even more are unaware of the added support that hospice provides for CHF patients.
In addition to general hospice guidelines, WV Caring consider the following symptoms in cardiac patients when determining hospice eligibility criteria for CHF.
- Compromised ejection fraction of <20%
- A poor response to diuretics and vasodilators
- Dyspnea at rest
- Angina at rest
- Impaired heart rhythms, contraction force of ventricular musicals and impaired blood supply to the heart
- Recurrent symptoms of CHF at rest
- Changes in appetite, unintentional weight loss
- NYHA Class IV functional status
- Relevant activity limitations and or impaired mobility
While only a physician is able to make the determination of whether a CHF patient meets the qualifications to be admitted to hospice, if you are seeing any of the above signs and symptoms with CHF or other end-stage cardiac conditions, it may be time to consider contacting WV Caring for hospice care.
WHAT WV CARING CAN DO FOR YOU
In the advanced stages of CHF, WV Caring provides an added level of support for cardiac patients and their families in managing CHF and other heart disease symptoms. Our clinical team is available to answer questions and provide support 24 hours a day to help control patient symptoms at home, avoiding late night visits to the emergency room and avoidable hospital admissions. This support gives the patient and family the time they need to get the most out of enjoying life and focus on what matters most.
Upon meeting the hospice criteria for CHF and starting hospice, care is customized for each patient. Services are covered by Medicare, Medicaid and most insurances. WV Under the Hospice Medicare Benefit, Part A, the care, medication, medical equipment and supplies related to the patient’s primary diagnosis are covered at 100%. WV Caring will work with each patient and family to meet their individual needs regardless of their ability to pay.
Each patient’s team includes nurses, physician, personal home aides, social workers, bereavement counselors, chaplains and volunteers all working alongside the cardiac patient and their family to address physical and emotional symptoms and provide spiritual support. The care team also provides education and training to caregiver and family on understanding the diagnosis, care plan, prognosis, administering medication and utilizing medical equipment.
WV Caring’s social workers are a resource, connecting you to services in the community and assisting in end-of-life planning and making funeral arrangements. In addition, volunteers are available to support the patient and family through companionship visits. These give family caregivers the chance to take time for themselves to rest, do some shopping, or visit with friends.
WV Caring’s goal is to simply to improve care and maintain the highest quality of life for its patients and families throughout every step of the journey. As an added support, bereavement is provided to the caregiver and family for twelve months after their loved one passes.
IT’S NEVER TO EARLY TO CALL WV CARING
While there is no cure for end-stage CHF, the added specialized care and support of hospice care can improve quality of life for cardiac patients, as well as their families and caregivers. WV Caring encourages CHF patients to begin talking with their physician about hospice early to ensure there is adequate time to discuss the patient’s wishes and options before a time of crisis.
We understand how difficult coping with an advanced illness must be, and we want you to know that you are not alone. WV Caring provides services to assist with end-of-life and grief-related needs along with physical and emotional needs.
Our team will come to you with our patient-focused care in private residence, assisted living facility, nursing home, or whenever you call home.
If your loved one needs hospice care, call us at 1-866-656-9790. If you aren’t sure if your loved one needs hospice, download our checklist here.