Cedars-Sinai Heart Institute and Palliative Care Program, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Palliat Med. 2012 Jan;15(1):12-5. doi: 10.1089/jpm.2011.0256. Epub 2012 Jan 4.
Heart failure (HF) in its chronic form is an irreversible and progressive disease. Palliative care (PC) interventions have traditionally been focused on patients with advanced cancer. We performed a pilot study to assess the feasibility of implementing the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for early PC intervention in patients with advanced HF who were seeking or received potentially curative therapies.
Twenty consecutive patients with advanced HF referred to PC from the heart transplant service with stage D, New York Heart Association (NYHA) class III-IV symptoms were analyzed retrospectively in a tertiary care setting. Data were reviewed to assess the clinical impact of PC intervention. Feedback was obtained to assess satisfaction of the patients, their families, and the health care professionals. An independent assessment of the impact of the PC service in the care of each patient was performed by a cardiologist and PC physician by use of a scoring system.
Twenty consecutive patients with HF were analyzed. PC consult was obtained for a variety of reasons. All patients complained of a high symptom burden. PC consultation resulted in a decrease in the use of opioids and increased patient satisfaction. Patients and their family members generally reported improved holistic care, continuity of care, more focused goals of care, and improved planning of treatment courses. The nonstandardized scoring system used to determine the impact of the PC service showed an average of moderate to significant impact when assessed by both a cardiologist and a PC physician.
PC consultation appears to be beneficial in the treatment and quality of life of advanced HF patients, independent of their prognosis. This pilot study demonstrated feasibility and sufficient evidence of clinical benefit to warrant a larger randomized clinical trial assessing the benefit of standard involvement by PC in patients with advanced HF, independent of the patient's prognosis or treatment goals.
慢性心力衰竭（HF）是一种不可逆转且呈进行性发展的疾病。姑息治疗（PC）干预措施传统上集中于晚期癌症患者。我们进行了一项试点研究，以评估在寻求或接受潜在治愈性治疗的晚期 HF 患者中实施美国心脏病学会/美国心脏协会（ACC/AHA）早期 PC 干预指南的可行性，这些患者的心力衰竭处于 D 期，纽约心脏协会（NYHA）分级为 III-IV 级。
在三级保健机构中，回顾性分析了 20 例连续就诊于心移植服务的晚期 HF 患者，这些患者被转诊至 PC，他们患有心力衰竭 D 期，NYHA 分级为 III-IV 级。评估 PC 干预的临床影响，审查数据。向患者、其家属和医疗保健专业人员征求对满意度的反馈。一位心脏病专家和一位姑息治疗医生使用评分系统独立评估 PC 服务对每位患者护理的影响。
分析了 20 例连续 HF 患者。因各种原因获得 PC 咨询。所有患者均主诉高症状负担。PC 咨询导致阿片类药物使用减少，患者满意度提高。患者及其家属普遍报告说整体护理、护理连续性、更有针对性的护理目标以及治疗方案规划得到改善。用于确定 PC 服务影响的非标准化评分系统显示，当由心脏病专家和姑息治疗医生评估时，平均具有中度至显著影响。
PC 咨询似乎对晚期 HF 患者的治疗和生活质量有益，与患者的预后无关。这项试点研究证明了可行性和充分的临床获益证据，足以支持更大规模的随机临床试验，评估在晚期 HF 患者中常规纳入 PC 的获益，而不考虑患者的预后或治疗目标。
