Gavazzi Antonello, Svanoni Fausto, De Maria Renata
U.S.C. di Cardiologia, Dipartimento Cardiovascolare, Ospedali Riuniti Bergamo.
G Ital Cardiol (Rome). 2012 Dec;13(12):827-36. doi: 10.1714/1188.13166.
The natural history of heart failure (HF) is characterized by a progressive decline in functional capacity, punctuated by acute heart destabilization episodes which contribute to a spiraling worsening course. Advanced HF affects one in four patients who are referred to the hospital for the syndrome and has an estimated yearly incidence of 12 000 new cases in Italy. Life expectancy is very limited, and in general less than 50% of advanced HF patients are alive at 1-2 years. Advanced HF patients show a high, not modifiable mortality, severe symptoms and impaired quality of life. Treatment goals should focus on the improvement of symptoms and quality of life, the aims of palliative care. Palliative consultations during hospital admissions reduce the number of interventions and procedures in the last stages of life, the length of stay in the intensive care unit and general ward. HF patients who receive home palliative care are more likely to die at home, in accordance with their expressed will. The research project RF-MAR-2007-67955 aims to analyze, through a prospective observational registry, the palliative care needs of HF patients in Italy, to answer the gaps in knowledge on symptom changes during the terminal stages of the disease, on the quality of communication between healthcare professionals, patients and their families and caregivers' needs.
心力衰竭（HF）的自然病程表现为功能能力逐渐下降，其间穿插着急性心脏失稳发作，这些发作导致病情呈螺旋式恶化。晚期HF影响着四分之一因该综合征而住院的患者，在意大利，其估计年发病率为12000例新病例。预期寿命非常有限，一般来说，1至2年后，不到50%的晚期HF患者仍然存活。晚期HF患者死亡率高且不可改变，症状严重，生活质量受损。治疗目标应侧重于改善症状和生活质量，这也是姑息治疗的目标。住院期间进行姑息治疗咨询可减少生命末期的干预措施和程序数量、重症监护病房和普通病房的住院时间。接受家庭姑息治疗的HF患者更有可能按照其意愿在家中去世。研究项目RF-MAR-2007-67955旨在通过前瞻性观察登记，分析意大利HF患者的姑息治疗需求，以填补疾病终末期症状变化、医护人员之间的沟通质量、患者及其家属以及护理人员需求方面的知识空白。
