Singapore heart patients' main concern is end-of-life care

Getting appropriate treatment and prolonging life span may not always be the goals of patients with chronic conditions. To heart failure patients in Singapore, as one study revealed, it was the challenge of planning for end-of-life care arising from the uncertainty in prognosis. The study was published in Proceedings of Singapore Healthcare recently.


While physical and psychological concerns were also there, many patients spoken to during focus group sessions highlighted end-of-life care issues, particularly in wanting to avoid undue prolongation of their life. They were worried about being a burden to their family members by requiring extensive care, spending family resources, or causing emotional distress.

As a result, patients often based care decisions on what they believed would be best for their family, said lead author of the study, Assistant Professor Chetna Malhotra, Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Duke-NUS Medical School.

Healthcare providers can help allay these fears by not only discussing treatment plans with patients and their family members but also by initiating Advanced Care Planning conversations.


Navigating the healthcare system proved to be a challenge for these patients too, according to the study. As many of them were elderly with multiple comorbidities, they faced difficulty in juggling instructions and multiple medications, as well as in deciding which advice or treatment plan to prioritise.

"Instead of visiting multiple physicians, it may be less complicated for them to consult one physician who is aware of all their conditions and is able to advise them holistically.

The physician can be backed by tertiary healthcare support should the need arise," said Asst Prof Malhotra.


"Heart failure however can be a challenge to manage as it is a rapidly developing field," said study co-author Adjunct Assistant Professor David Sim, Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS).

There are several useful clinical guidelines such as the ones provided by American Heart Association, European Society of Cardiology and Ministry of Health, Singapore.

"These guidelines are very comprehensive. Primary care physicians just need to keep in mind that heart failure is a chronic disease which needs a multidisciplinary approach, and keep up-to-date with the latest information," he added.