Lewin Warren Harris, Cheung Wendy, Horvath A Nina, Haberman Shana, Patel Archna, Sullivan Dorothy
1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.
2 Cardiac Function Telemetry Unit, Heart Function, Supportive Cardiology and Cardiovascular Rehabilitation Clinics, North York General Hospital , Toronto, Ontario, Canada .
J Palliat Med. 2017 Oct;20(10):1112-1119. doi: 10.1089/jpm.2016.0317. Epub 2017 May 4.
Heart failure (HF) affects ∼600,000 Canadians and is a chronic, life-limiting illness marked by exacerbations of distressing symptoms requiring acute medical management, typically sought in Canada's emergency departments. HF often has an unpredictable illness trajectory and is a chronic terminal illness with a poor prognosis. Patients living with advanced HF have difficulty in accessing palliative care (PC) supports, which can result in unnecessary suffering as their HF progresses and they near end of life (EOL). This is, in part, due to a lack of research, helping clinicians to identify patients who are approaching EOL. In addition, the unpredictable nature of illness progression often precludes access to most EOL resources in our current prognosis-dependent healthcare system. PC teams focus on optimizing quality of life through symptom management and ensure that care plans are congruent with patient and family preferences. A PC team was embedded into our institution's existing HF team. Findings show that integration of an embedded model of PC delivery for patients living with advanced HF led to overwhelming positive patient and family feedback while providing timely advance care planning discussions that may be associated with beneficial patient, family, and system outcomes. These outcomes can be used to inform public policy and speak to a cost-effective patient and family-centered approach for providing care to individuals and families living with advanced HF.
心力衰竭（HF）影响着约60万加拿大人，是一种慢性、危及生命的疾病，其特征是令人痛苦的症状加重，需要进行急性医疗处理，通常在加拿大的急诊科进行。HF的疾病轨迹往往不可预测，是一种预后不良的慢性终末期疾病。晚期HF患者难以获得姑息治疗（PC）支持，随着HF病情进展和接近生命终末期（EOL），这可能导致不必要的痛苦。部分原因是缺乏研究来帮助临床医生识别接近EOL的患者。此外，疾病进展的不可预测性往往使患者无法在我们当前依赖预后的医疗系统中获得大多数EOL资源。PC团队专注于通过症状管理优化生活质量，并确保护理计划符合患者和家属的偏好。一个PC团队被纳入了我们机构现有的HF团队。研究结果表明，为晚期HF患者提供嵌入式PC服务模式的整合，带来了患者和家属压倒性的积极反馈，同时提供了及时的预先护理计划讨论，这可能与有益的患者、家属和系统结果相关。这些结果可用于为公共政策提供信息，并说明一种具有成本效益的以患者和家属为中心的方法，为晚期HF患者及其家庭提供护理。
