Division of Geriatrics, University of California at San Francisco, USA.
Curr Opin Support Palliat Care. 2009 Dec;3(4):247-51. doi: 10.1097/SPC.0b013e3283325024.
Hospitalization for heart failure is a critical event associated with high rates of readmissions, morbidity, and mortality. This review examines the role of hospitalization for heart failure as an opportunity to assess comprehensive patient needs including palliative care needs.
Recent evidence demonstrates that institution of a comprehensive care plan at discharge reduces the high rates of readmissions and death seen in patients with heart failure. The chronic progressive nature of heart failure, with its concomitant limitations in functioning, significant psychosocial distress, and risk of death at all stages of illness creates a need for palliative care services that span the disease trajectory. These services include symptom management, psychosocial care, advance care planning, assistance in defining goals of care, and family/caregiver support and should be provided simultaneously with optimal medical management. Hospice is also underutilized.
Hospitalization for heart failure should serve as an opportunity to assess, introduce, and provide comprehensive care that includes palliative care alongside optimal medical management. Palliative care services have the potential to positively impact the health and quality of life of patients with heart failure and should be integrated as an ongoing key component of their care.
心力衰竭住院是与高再入院率、发病率和死亡率相关的关键事件。本综述探讨了心力衰竭住院作为评估患者全面需求（包括姑息治疗需求）机会的作用。
最近的证据表明，出院时实施综合护理计划可降低心力衰竭患者再入院率和死亡率居高不下的问题。心力衰竭是一种慢性进行性疾病，其功能受限、严重的心理社会困扰以及在疾病各个阶段死亡的风险，这就需要提供贯穿疾病全程的姑息治疗服务。这些服务包括症状管理、心理社会关怀、预先护理计划、协助确定护理目标以及为患者家属/照顾者提供支持，应与最佳的医疗管理同时提供。临终关怀的利用率也很低。
心力衰竭住院应作为评估、引入和提供全面护理的机会，包括姑息治疗和最佳的医疗管理。姑息治疗服务有可能积极改善心力衰竭患者的健康和生活质量，应将其作为他们治疗的一个持续的关键组成部分进行整合。
