Palliative Care Needs of Patients With Advanced Heart Failure at a Cardiac Care Unit in Mtrh, Kenya: A Census Study
Authors: WAMUKOBOLE DAVID LUBANGA , Hussein Hussein Elias , Shikanga Mainard Shikanga 
Published: July 2023

Abstract

Background
A growing problem in Sub-Saharan Africa is Heart Failure. In its advanced stages, heart failure causes significant morbidity and is a frequent cause of mortality. As the illness progresses, a lack of physical health may overshadow psychological, social, and existential distress.
Objective
To assess the Palliative Care needs of patients with Advanced Heart Failure at the Cardiac Care Unit (CCU) in Moi Teaching Referral Hospital (MTRH).
Methods
A Census study design was carried out at CCU in MTRH for patients with Advanced Heart Failure. Structured questionnaires and the use of the Africa Palliative Care Association Palliative Care Outcome Scale (APCA POS) tool were used to collect data. The study population involved patients 18 years of age and older who were hospitalized at the Cardiac Care Unit in MTRH with Advanced Heart Failure. SPSS software version 23.0 was employed to analyze the data in this study to determine any relationships between variables based on data obtained from questionnaires. Bivariate analysis with Pearson’s chi-square test was used to compare the proportions. A P value of < 0.05 was considered statistically significant at the 95% Confidence Interval. The significant variables were then subjected to Multi-variate logistic regression for further analysis of the association of satisfaction with the care they received. The participant's autonomy and anonymity were maintained, and any information shared by them was confidential.
Findings:
A convenience sample of 20 patients completed the questionnaire, with a response rate of 100%. Their mean age was 54.5 years, ranging from 40 to 80 years. More than half of them were male (60%). Nearly all of the participants have co-morbidities; Hypertension was the most common (35%), and they were casual workers with an income of Ksh 10,000–20,000 monthly living more than 20 kilometers away from a health care facility (MTRH), with a diagnosis of advanced heart failure NYHA Class III (65%). They had been hospitalized 2.75 ± 1.21 times over the past 12 months. Information, help, and advice significantly predicted patients’ satisfaction, F (2, 18) = 128.466, p < 0.001, which indicates that information, help, and advice can play a significant role in shaping patients’ satisfaction (β = -0.252, p < .001). These results clearly show the positive effect of the information, help, and advice given to the patient and caregivers. Moreover, the R2 = .877 indicates that the model explains 87.7% of the variance in patients' satisfaction.
Conclusion
This study suggests that patients would benefit from holistic care, such as a palliative approach that is aimed at providing multidimensional symptom management. A palliative approach to services should be provided alongside heart failure management. Because of this, patients with heart failure and those who are caring for them require all-encompassing palliative care interventions that address more than just physical symptoms to assist them throughout the entire process.
Recommendation:
To address the demands that are still not being satisfied by the conventional approaches to heart failure care, future research efforts must concentrate on creating and testing interventions with heart failure patients and their caregivers in a range of care delivery settings.