Pak Esther, Wald Joyce, Kirkpatrick James N
Palliative Care, Hospital of the University of Pennsylvania, Ravdin 2, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Cardiology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, East Pavilion, 2nd Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Clin Geriatr Med. 2016 May;32(2):385-97. doi: 10.1016/j.cger.2016.01.005.
The care of patients with severe cardiovascular disease and multimorbidity entails complex medical decision-making especially at the end of life. Proven therapies must be incorporated into the context of patient preferences, values, and goals to achieve effective titration of medications and appropriate initiation and withdrawal of cardiac device therapies. As patients decline in the terminal stages, it is important to modify medical and device therapies in accordance with goals and values, and with hemodynamic changes, increasing multimorbidity, and accumulating symptom burden. The provision of effective end of life care for those with cardiovascular disease and multimorbidity requires cooperation between palliative care, specialty care, and primary care.
对患有严重心血管疾病和多种合并症的患者进行护理，尤其是在生命末期，需要复杂的医疗决策。必须将经过验证的治疗方法纳入患者的偏好、价值观和目标背景中，以实现药物的有效滴定以及心脏设备治疗的适当启动和停用。随着患者在终末期病情恶化，根据目标和价值观，以及血流动力学变化、合并症增加和症状负担加重来调整医疗和设备治疗非常重要。为患有心血管疾病和多种合并症的患者提供有效的临终护理需要姑息治疗、专科护理和初级护理之间的合作。
