Davis Mellar P, Albert Nancy M, Young James B
The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA.
Am J Hosp Palliat Care. 2005 May-Jun;22(3):211-22. doi: 10.1177/104990910502200311.
Heart failure is the major cause of morbidity and mortality in the United States. Stage D heart failure has a greater mortality rate than many cancers and has equivalent symptom burden and severity. There has been a paradigm shift in our understanding of the pathophysiology of heart failure. Progressive heart failure is associated with ventricular remodeling and a maladaptive neurohumoral response. Drug classes have evolved that curtail ventricular remodeling, and blunt neurohumoral responses reduce morbidity and mortality. Despite combination drug and device therapies, the management of Stage D heart failure includes palliation. Both cardiology and palliative specialists need to learn from one another in order to palliate these highly symptomatic patients. Such collaboration will enhance care and are the basis for well-conceived research trials.
心力衰竭是美国发病和死亡的主要原因。D期心力衰竭的死亡率高于许多癌症，且症状负担和严重程度相当。我们对心力衰竭病理生理学的理解发生了范式转变。进行性心力衰竭与心室重构和适应性不良的神经体液反应有关。已经出现了能够减少心室重构的药物类别，抑制神经体液反应可降低发病率和死亡率。尽管有药物和器械联合治疗，但D期心力衰竭的管理仍包括姑息治疗。心脏病专家和姑息治疗专家都需要相互学习，以便为这些症状严重的患者提供姑息治疗。这种合作将改善护理，也是精心设计的研究试验的基础。
