Tanner Craig E, Fromme Erik K, Goodlin Sarah J
Division of General Internal Medicine and Geriatrics, Portland VAMC and Oregon Health and Science University, Portland, OR, USA.
Congest Heart Fail. 2011 Sep-Oct;17(5):235-40. doi: 10.1111/j.1751-7133.2011.00245.x. Epub 2011 Aug 1.
Advanced heart failure (HF) is a life-shortening condition, yet there are increasing treatments and implantable devices available to clinicians to manage patients with advanced HF. Planning for adverse events and the end of life, formulated as "preparedness planning," can be integrated into HF care early in illness. Discussions that acknowledge the uncertainty of HF course and length of life and incorporate patient and family goals and values facilitates this planning. Clear processes for weighing potential benefits and burdens of interventions and therapies should accompany decision-making. Device implantation decision-making can acknowledge alternative avenues of care to the device and identify situations in which the device might be deactivated in the future. Symptom assessment and management potentially improve quality of life in patients with advanced HF. Management of symptoms should integrate HF therapies as well as other treatments. Collaboration between HF providers, palliative care clinicians, and, if appropriate, hospice clinicians will improve care for HF patients and their families.
晚期心力衰竭（HF）是一种会缩短寿命的疾病，但临床医生可用于治疗晚期HF患者的治疗方法和植入式设备越来越多。将针对不良事件和生命终结的规划，即“预案规划”，在疾病早期纳入HF护理中。承认HF病程和寿命不确定性并纳入患者及家属目标和价值观的讨论有助于这种规划。决策过程中应明确权衡干预措施和治疗潜在益处与负担的流程。设备植入决策可认可除设备之外的其他护理途径，并确定未来可能停用设备的情况。症状评估和管理有可能改善晚期HF患者的生活质量。症状管理应整合HF治疗方法以及其他治疗。HF医疗服务提供者、姑息治疗临床医生以及（如适用）临终关怀临床医生之间的协作将改善对HF患者及其家属的护理。
