Wednesday, 7 July 2010

The heart and the kidneys – til death do us part

Increasingly patients with severe heart failure are managed in the community by specialist heart failure nurses working with primary care and cardiology teams. Their input is crucial, they’re often in the best position to detect early signs that the condition is worsening and to act to prevent acute exacerbations. Given that renal and heart failure share many features, indeed death from heart failure or renal failure rarely occurs in isolation, there is a real opportunity to develop, commission and deliver conservative kidney care and heart failure services together.

End of Life Care in Heart Failure sets out to raise awareness of the supportive and palliative care needs of people living or dying with progressive heart failure, to facilitate commissioning of services tailored to meet those needs. It comes hard on the heels of End of Life Care in Advanced Kidney Disease (a framework for implementation) published by NHS Kidney Care. Both build on the National End of Life Care Strategy that aims to ensure provision of expert end of life care moves beyond hospices and specialist palliative care services to include all those with life limiting conditions in all care settings.

The heart failure framework complements the kidney care approach, there is a particular focus on advanced care planning and the importance of multi-disciplinary working including social care is emphasised. The recent release of information about the place of death of people dying from kidney disease, with the majority dying in hospital, compared to cancer related deaths where the majority get to die in their own homes or hospices, may also signify inadequate Local Authority and social care provision in conservative kidney care.

Both End of Life Care in Advanced Kidney Disease and End of Life Care in Heart Failure are clearly written, crisp and jargon free. They stand as pillars that together make the case for joined up community delivered care in these 2, so similar, vascular conditions.