Goodlin Sarah J
Patient-Centered Education and Research, 681 East 17th Avenue, Salt Lake City, Utah 84103, USA.
J Am Coll Cardiol. 2009 Jul 28;54(5):386-96. doi: 10.1016/j.jacc.2009.02.078.
Symptoms and compromised quality of life prevail throughout the course of heart failure (HF) and thus should be specifically addressed with palliative measures. Palliative care for HF should be integrated into comprehensive HF care, just as evidence-based HF care should be included in end-of-life care for HF patients. The neurohormonal and catabolic derangements in HF are at the base of HF symptoms. A complex set of abnormalities can be addressed with a variety of interventions, including evidence-based HF care, specific exercise, opioids, treatment of sleep-disordered breathing, and interventions to address patient and family perceptions of control over their illness. Both potential sudden cardiac death and generally shortened length of life by HF should be acknowledged and planned for. Strategies to negotiate communication about prognosis with HF patients and their families can be integrated into care. Additional evidence is needed to direct care at the end of life, including use of HF medications, and to define management of multiple sources of distress for HF patients and their families.
在心力衰竭（HF）的整个病程中，症状普遍存在且生活质量受损，因此应通过姑息治疗措施予以专门解决。HF的姑息治疗应融入全面的HF护理中，正如基于证据的HF护理应纳入HF患者的临终护理一样。HF中的神经激素和分解代谢紊乱是HF症状的基础。一系列复杂的异常情况可以通过多种干预措施来解决，包括基于证据的HF护理、特定运动、阿片类药物、睡眠呼吸障碍的治疗以及解决患者和家属对疾病控制感的干预措施。应认识到HF可能导致的心源性猝死以及总体上缩短的寿命，并为此制定计划。与HF患者及其家属就预后进行沟通的策略可以融入护理中。需要更多证据来指导临终护理，包括HF药物的使用，并确定针对HF患者及其家属多种痛苦来源的管理方法。
