Davidson Patricia M, Macdonald Peter S, Newton Phillip J, Currow David C
St Vincent's & Mater Health, Curtin Health Innovation Research Institute, Curtin University, Sydney, New South Wales.
Aust Fam Physician. 2010 Dec;39(12):916-20.
Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms.
This article summarises the fundamentals of implementing palliative care in general practice and provides guidelines on caring for chronic heart failure patients at the end of life.
The high mortality in chronic heart failure underscores the importance of effective communication, symptom management and advanced care planning. The unpredictability and uncertainty around the timing of death mean that individuals, and their families, may be less likely to have an understanding of their prognosis or have access to supportive and palliative care. Ideally, patients with symptomatic chronic heart failure should be managed in collaboration with a multidisciplinary heart failure program. Symptom management can be achieved by additive therapies and access to specialist palliative care services should be considered when the symptom burden is high.
慢性心力衰竭很常见，尤其是在老年人中，且常伴有合并症。终末期心力衰竭患者可能症状严重，需要仔细监测和调整治疗以改善症状。
本文总结了在全科医疗中实施姑息治疗的基本要点，并提供了临终关怀慢性心力衰竭患者的指南。
慢性心力衰竭的高死亡率凸显了有效沟通、症状管理和晚期护理计划的重要性。死亡时间的不可预测性和不确定性意味着个人及其家人可能不太了解他们的预后，也难以获得支持性和姑息性护理。理想情况下，有症状的慢性心力衰竭患者应由多学科心力衰竭项目协同管理。可通过附加治疗实现症状管理，当症状负担较重时应考虑获得专科姑息治疗服务。
