Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Curr Opin Support Palliat Care. 2013 Mar;7(1):21-8. doi: 10.1097/SPC.0b013e32835c4915.
Advanced heart failure (AHF) is an increasingly important field. Both the population of AHF patients and the therapeutic and diagnostic interventions available are expanding, creating a host of difficult ethical challenges. This article discusses these important issues and proposes an approach to caring for AHF patients.
Recent guidelines and clinical trials describe the benefits of costly and invasive therapies for AHF, such as ventricular assist devices and cardiac resynchronization therapy which prolong life and improve symptoms but may create burdens and conflict over deactivation at the end of life. Prognostication, informed consent, and early involvement of palliative care are central to addressing the decision-making challenges raised by these devices. Societal concerns such as cost-effectiveness and distributive justice will play an increasingly important role in the dissemination of these devices.
More research, increased end-of-life education, emphasis on advance directives, a more comprehensive informed consent process, and a true multidisciplinary approach are needed to provide optimal care for patients with AHF.
心力衰竭（HF）是一个日益重要的领域。HF 患者人群以及可用的治疗和诊断干预措施都在不断扩大，这带来了一系列棘手的伦理挑战。本文讨论了这些重要问题，并提出了一种治疗 HF 患者的方法。
最近的指南和临床试验描述了昂贵且有创的 HF 治疗方法的益处，例如心室辅助装置和心脏再同步治疗，这些治疗方法可延长生命并改善症状，但可能在生命末期造成停用的负担和冲突。预后、知情同意和姑息治疗的早期介入是解决这些设备带来的决策挑战的核心。成本效益和分配正义等社会关注问题将在这些设备的传播中发挥越来越重要的作用。
需要更多的研究、更多的临终教育、强调预先指示、更全面的知情同意过程以及真正的多学科方法，为 HF 患者提供最佳护理。
