Cheang Mun Hong, Rose Gabrielle, Cheung Chi-Chi, Thomas Martin
Department of Heart Failure , The Heart Hospital, University College London Hospital , London , UK.
Camden Clinical Commissioning Group, London , UK.
Open Heart. 2015 Jan 15;2(1):e000188. doi: 10.1136/openhrt-2014-000188. eCollection 2015.
Palliative care (PC) in heart failure (HF) is beneficial and recommended in international HF guidelines. However, there is a perception that PC is underutilised in HF in the UK. This exploratory study aims to investigate, from a PC perspective, this perceived underutilisation and identify problems with current practice that may impact on the provision of PC in HF throughout the UK.
A prospective survey was electronically sent to PC doctors and nurses via the UK Association for Palliative Medicine and adult PC teams listed in the UK Hospice directory.
We received 499 responses (42%-PC consultants). Although PC provision for patients with HF was widespread, burden on PC services was low (47% received less than 10 referrals annually). While PC was acknowledged to have a role in end-stage HF, there were differing views about the optimal model of care. Levels of interdisciplinary collaboration (58%) and mutual education (36%) were low. There were frequent reports that end-of-life matters were not addressed by cardiology prior to PC referral. Moreover, 24% of respondents experienced difficulties with implantable cardioverter defibrillator deactivation.
Low HF referrals despite widespread availability of PC services and insufficient efforts by cardiology to address PC issues may contribute to the perception that PC is underutilised in HF. The challenges facing PC and HF identified here need to be further investigated and addressed. These findings will hopefully promote awareness of PC issues in HF and encourage debate on how to improve PC support for this population.
心力衰竭（HF）的姑息治疗（PC）有益且在国际HF指南中得到推荐。然而，人们认为PC在英国HF患者中的应用未得到充分利用。这项探索性研究旨在从PC的角度调查这种未充分利用的情况，并确定当前实践中可能影响全英国HF患者PC服务提供的问题。
通过英国姑息医学协会和英国临终关怀目录中列出的成人PC团队，以电子方式向PC医生和护士发送了一项前瞻性调查。
我们收到了499份回复（42%为PC顾问）。虽然为HF患者提供PC服务很普遍，但PC服务的负担较轻（47%的团队每年收到的转诊少于10例）。虽然PC在HF终末期的作用得到认可，但对于最佳护理模式存在不同观点。跨学科协作水平（58%）和相互教育水平（36%）较低。经常有报告称，在PC转诊之前，心脏病学方面未处理临终事宜。此外，24%的受访者在植入式心脏复律除颤器停用方面遇到困难。
尽管PC服务普遍可用，但HF转诊量较低，且心脏病学方面在解决PC问题上的努力不足，这可能导致人们认为PC在HF中未得到充分利用。此处确定的PC和HF面临的挑战需要进一步调查和解决。这些发现有望提高对HF中PC问题的认识，并鼓励就如何改善对这一人群的PC支持展开辩论。
