Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA Adult and Child Center for Health Outcomes and Research and Delivery Sciences, University of Colorado School of Medicine, Aurora, CO, USA Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA.
Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA Adult and Child Center for Health Outcomes and Research and Delivery Sciences, University of Colorado School of Medicine, Aurora, CO, USA Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA
BMJ. 2016 Apr 14;353:i1010. doi: 10.1136/bmj.i1010.
Despite advances in cardiac therapy, heart failure (HF) remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, and healthcare systems. Palliative care is a multidisciplinary approach to care that focuses on communication, shared decision making, and advance care planning; provides relief from pain and other distressing symptoms; integrates psychological and spiritual aspects of care; and offers a support system to help families cope during illness and bereavement. Palliative care has applications across the stages of heart failure, including early in the course of illness, often in conjunction with other therapies that are intended to prolong life. However, the incorporation of palliative care into the management of heart failure has been suboptimal for several reasons: uncertainty in the disease trajectory, failure to reward communication between healthcare providers and patients, siloed care, lack of knowledge, overlay of comorbidity and frailty, life saving devices with complex trade-offs, and a limited evidence base. This review will summarize the current literature on the emerging role of palliative care in patients with heart failure and the challenges and opportunities for its integration into routine care. It will discuss current initiatives and future directions of the collaborative relationship between the palliative care and heart failure disciplines.
尽管心脏治疗取得了进展，但心力衰竭（HF）仍然是一种进行性的、高度有症状的、致命的疾病，给患者、护理人员和医疗保健系统带来了巨大的压力。姑息治疗是一种多学科的护理方法，侧重于沟通、共同决策和预先护理计划；提供疼痛和其他痛苦症状的缓解；整合护理的心理和精神方面；并提供一个支持系统，帮助家庭在患病和丧亲期间应对。姑息治疗适用于心力衰竭的各个阶段，包括疾病早期，通常与旨在延长生命的其他治疗方法结合使用。然而，由于以下原因，姑息治疗在心力衰竭管理中的应用并不理想：疾病轨迹的不确定性、未能奖励医疗保健提供者和患者之间的沟通、孤立的护理、缺乏知识、合并症和脆弱性的重叠、具有复杂权衡的救生设备，以及有限的证据基础。这篇综述将总结姑息治疗在心力衰竭患者中新兴作用的现有文献，以及将姑息治疗纳入常规护理的挑战和机遇。它将讨论姑息治疗和心力衰竭学科之间合作关系的当前举措和未来方向。
