Bedet A, Garçon P, Boulogne M, Richard J F, Opatowski L, Moubarak G, Rejasse G, Cador R
Service de réanimation médicale, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Service de cardiologie, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
Ann Cardiol Angeiol (Paris). 2015 Sep;64(4):255-62. doi: 10.1016/j.ancard.2015.02.002. Epub 2015 Mar 29.
Advanced heart failure incidence is in progression. Palliative care access remains difficult due to its unpredictable course. The aim of this study was to describe the characteristics of patients admitted in Cardiology Intensive Care Unit for advanced heart failure who received palliative care and compare them to the whole population of acute heart failure hospitalized in the same period.
The patients hospitalized for acute heart failure were retrospectively included from 2009 to 2013. We identified among them those who received palliative care. Specific caring was decided in pluridisciplinary meeting.
On 940 patients included, 42 patients (4.5%) receive palliative care. Ischemic heart disease was the main etiology (n=19; 45.2%). Right ventricular dysfunction (n=34; 80.9%) was associated with supra-ventricular arrhythmia (n=28; 66.7%). Twenty-eight patients (57.1%) have died in hospital, 9 (21.4%) were referred to a palliative care unit and 8 (19.1%) was discharged or referred to a rehabilitation center. Time between inclusion and death was 6 days on average. Intra-hospital mortality in control group was 6.8%.
Palliative care in cardiology is uncommon and has often been too late because of its poor adaptability to advanced heart failure. It is, as consequence, necessary to identify the prognostic factors of these patients in order to propose a personalized care and to adjust the intensity of care ahead of the terminal evolution of heart failure.
晚期心力衰竭的发病率呈上升趋势。由于其病程不可预测，姑息治疗的可及性仍然困难。本研究的目的是描述在心脏病重症监护病房接受姑息治疗的晚期心力衰竭患者的特征，并将他们与同期住院的急性心力衰竭患者总体进行比较。
回顾性纳入2009年至2013年因急性心力衰竭住院的患者。我们在其中确定了接受姑息治疗的患者。在多学科会议上决定具体的护理措施。
在纳入的940例患者中，42例（4.5%）接受了姑息治疗。缺血性心脏病是主要病因（n = 19；45.2%）。右心室功能障碍（n = 34；80.9%）与室上性心律失常（n = 28；66.7%）相关。28例（57.1%）患者在医院死亡，9例（21.4%）被转诊至姑息治疗病房，8例（19.1%）出院或转诊至康复中心。纳入至死亡的平均时间为6天。对照组的院内死亡率为6.8%。
心脏病学中的姑息治疗并不常见，而且由于其对晚期心力衰竭的适应性差，往往为时已晚。因此，有必要识别这些患者的预后因素，以便提供个性化护理，并在心力衰竭终末期进展之前调整护理强度。
